title: Estrogen alone in postmenopausal women and breast cancer detection by means of mammography and breast biopsy.
abstract: OBJECTIVE
  As the influence of estrogen alone on breast cancer detection is not established, we examined this issue in the Women's Health Initiative trial, which randomly assigned 10,739 postmenopausal women with prior hysterectomy to conjugated equine estrogen (CEE; 0.625 mg/d) or placebo.
  
  
  METHODS
  Screening mammography and breast exams were performed at baseline and annually. Breast biopsies were based on clinical findings. Effects of CEE alone on breast cancer detection were determined by using receiver operating characteristic (ROC) analyses of mammogram performance.
  
  
  RESULTS
  After a 7.1-year mean follow-up, fewer invasive breast cancers were diagnosed in the CEE than in the placebo group, but the difference was not statistically significant. Use of CEE alone increased mammograms with short-interval follow-up recommendations (cumulative, 39.2% v 29.6.3%; P < .001) but not abnormal mammograms (ie, those suggestive of or highly suggestive of malignancy; cumulative, 7.3% v 7.0%; P = .41). Breast biopsies were more frequent in the CEE group (cumulative, 12.5% v 10.7%; P = .004) and less commonly diagnosed as cancer (8.9% v 15.8%, respectively, with positive biopsies; P = .04). Mammographic breast cancer detection in the CEE group was significantly compromised only in the early years of use.
  
  
  CONCLUSIONS
  CEE alone use for 5 years results in approximately one in 11 and one in 50 women having otherwise avoidable mammograms with short-interval follow-up recommendations or breast biopsies, respectively. Although the breast biopsies on CEE were less commonly diagnosed as cancer, breast cancer detection was not substantially compromised. These findings differ from estrogen-plus-progestin use, for which significantly increased abnormal mammograms and a compromise in breast cancer detection are seen.
authors.affiliation: Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, University of California-Los Angeles, 1124 W. Carson St., Torrance, CA 90502, USA. rchlebowski@gmail.com
authors.forename: Rowan T
authors.initials: RT
authors.lastname: Chlebowski
authors.forename: Garnet
authors.initials: G
authors.lastname: Anderson
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.forename: Mary
authors.initials: M
authors.lastname: Pettinger
authors.forename: Shagufta
authors.initials: S
authors.lastname: Yasmeen
authors.forename: Dorothy
authors.initials: D
authors.lastname: Lane
authors.forename: Robert D
authors.initials: RD
authors.lastname: Langer
authors.forename: F Allan
authors.initials: FA
authors.lastname: Hubbell
authors.forename: Anne
authors.initials: A
authors.lastname: McTiernan
authors.forename: Susan
authors.initials: S
authors.lastname: Hendrix
authors.forename: Robert
authors.initials: R
authors.lastname: Schenken
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
mesh_terms: D017677:Age Distribution; D000368:Aged; D019540:Area Under Curve; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods; D004966:Estrogens, Conjugated (USP) / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007150:Immunohistochemistry; D015994:Incidence; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D017698:Postmenopause; D011336:Probability; D012372:ROC Curve; D012016:Reference Values; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors
chemical_list: D004966:Estrogens, Conjugated (USP)