Impact of hormone therapy on false-positive recall and costs among women undergoing screening mammography.
OBJECTIVE
We sought to evaluate the effects of hormone therapy (HT) on false-positive (FP) recall for additional breast evaluation and costs.


METHODS
We undertook an observational cohort study of women ages 40-80 years with 2 mammography screenings in an integrated delivery system.


METHODS
FP recall, defined as mammograms resulting in a radiologist's recommendation for additional imaging, ultrasound, or invasive procedures among disease-free women, was compared for nonusers, initiators, discontinuers, and continuers of HT. Differences in health care costs by HT were assessed for total, primary care, specialty, laboratory, radiology, inpatient, mental health, and pharmacy.


RESULTS
There was no association between HT and FP recall among women ages 40-49 years. Among women 50 years or older, current HT users, ie, initiators and continuers, had increased odds of FP recall (odds ratio; 95% confidence interval) compared with nonusers (1.2; 1.0-1.4 for women 50-59 years; 1.8; 1.5-2.2 for women 60-69; and 1.7; 1.4-2.0 for women 70-80 years). Among women 50-59 years, the odds of FP recall were attributed to opposed HT (ie, estrogen+progestin). Increases in FP recall among HT users 60 years and older was maintained for initiators, continuers, opposed, and unopposed (estrogen only). Increases in FP recall among HT users were for imaging and ultrasound but not invasive procedures. Costs for current HT users during the 12 months after screening were not higher than nonusers, except for pharmacy and outpatient mental health.


CONCLUSIONS
The relationship between HT use and FP recall is greatest among older women and does not result in a differential use of invasive procedures.
Boudreau
Denise M
DM
Center for Health Studies, Group Health Cooperative, Seattle, Washington 98101-1448, USA. boudreau.d@ghc.org
Buist
Diana S M
DS
Rutter
Carolyn M
CM
Fishman
Paul A
PA
Beverly
Kevin R
KR
Taplin
Stephen
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D015914:Estrogen Replacement Therapy; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008327:Mammography; D011939:Mental Recall; D008875:Middle Aged; D014861:Washington