title: Factors associated with non-compliance with hormone therapy cessation before screening mammography.
abstract: OBJECTIVE
  To evaluate factors associated with non-compliance with discontinuation of hormone therapy (HT) within a study on the effect of HT cessation on mammography performance.
  
  
  METHODS
  This randomized, controlled trial was conducted at Group Health, a health plan in Washington State, USA. Eligibility included: age 45-80 years; due for screening ('study') mammogram; and prior screening mammogram while using HT. We randomized 1704 women to no cessation (n = 567), 1-month (n = 570), or 2-month cessation (n = 567), and called participants before cessation to review instructions. We collected self-reported data at randomization (baseline) and before the study mammogram, including symptoms and compliance. This analysis includes women randomized to 1-month or 2-month cessation with complete baseline and follow-up questionnaires (n = 883).
  
  
  RESULTS
  Most participants were using unopposed estrogen (63.3%) and intended to continue HT (90%); 9.6% were non-compliant with HT cessation. Comparing 2-month vs. 1-month cessation, the age and body mass index (BMI)-adjusted relative risk (RR) for non-compliance was 1.72 (95% confidence interval (CI) 1.12-2.60). Baseline variables associated with non-compliance included: age ≤55 vs. >55 years (RR 2.34; 95% CI 1.34-4.41); BMI < 25 vs. BMI ≥30 kg/m 2 (RR 1.63; 95% CI 1.01-2.63); unopposed estrogen vs. estrogen plus progestin (RR 1.59; 95% CI 1.01-2.51); using HT to manage sleep (RR 1.80; 95% CI 1.20-2.71); severe vs. no night sweats (RR 1.68; 95% CI 1.03-2.74); and night sweats that interfered with sleep (RR 1.78; 95% CI 1.02-3.11).
  
  
  CONCLUSIONS
  Non-compliance with HT cessation before screening mammogram was associated with younger age, lower BMI, symptom severity and use of unopposed estrogen. Alternatives for menopause symptom management are needed to assist women with HT cessation.
authors.affiliation: Group Health Research Institute, Seattle, Washington State 98101, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Newton
authors.forename: M L
authors.initials: ML
authors.lastname: Anderson
authors.forename: S D
authors.initials: SD
authors.lastname: Reed
authors.forename: E J A
authors.initials: EJ
authors.lastname: Bowles
authors.forename: D S M
authors.initials: DS
authors.lastname: Buist
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D055088:Early Detection of Cancer; D015914:Estrogen Replacement Therapy; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D028761:Withholding Treatment
chemical_list: D004967:Estrogens