Cancer: Drop in hormone therapy spurs drop in mammo rates

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A decline in hormone therapy (HT) use among women ages 50 to 64 was linked with lower mammogram rates among these women, according to a study published Aug. 22 in Cancer. The study suggested that when women stop seeing their physicians for HT prescriptions, physicians do not have the opportunity to remind their patients about when mammograms are due.

In 2005, mammography rates, which had been increasing every year since 1987, fell for the first time. The authors hypothesized that the drop may have been tied to a drop in HT use. Current HT users tend to have higher mammography rates, which may be because physicians order screening mammography for these women during the annual visit when they renew the HT prescription.

However, HT use plummeted between 2000 and 2005 after a 2002 study published in the Journal of the American Medical Association linked its use with breast cancer. If women ceased the HT prescription visits, physicians may have lost the opportunity to remind them about mammography, according to the researchers.

Nancy Breen, PhD, of the applied research program at National Cancer Institute in Rockville, Md., and colleagues tested whether the drop in HT use correlated directly with the drop in mammography by analyzing data from the 2000 and 2005 National Health Interview Surveys (NHIS).

The sample comprised 7,125 women in 2000 and 7,387 in 2005. The analysis examined the following variables: receipt of mammography within two years of the interview (dependent variable), race-ethnicity, immigrant status, medical or health insurance, usual source of medical care, current HT use and health status.

Breen and colleagues found women ages 50 to 64 were more likely to report a recent mammogram if they also reported more education, a usual source of care, private health insurance, any race except non-Hispanic Asian, talking with an obstetrician/gynecologist or other physician in the past 12 months or current HT use.

“Women aged > 65 years were more likely to report a recent mammogram if they also reported younger age (ages 65 to 74 years), more education, a usual source of care, having Medicare Part B or other supplemental Medicare insurance, excellent health, any race except non-Hispanic Asian, talking with an obstetrician/gynecologist or other physician in the past 12 months or current HT use,” wrote Breen.

Between 2000 and 2005, recent screening declined 4.7 percentage points for women ages 50 to 64 years and 2.5 percentage points for women ages 65 years and older.

Women ages 50 to 64 had lower screening rates after they stopped HT use, but the authors did not observe the association between HT use and mammography for women ages 65 and older.

Breen and colleagues emphasized the significance of the findings and their importance in understanding the relation between HT use and mammography.

“Our research corroborates that a doctor's recommendation is an important step in getting a mammogram and it shows that when circumstances change--such as evidence about HT--t can upset the balance and lead to unanticipated and undesirable changes in mammography use,” Breen said in a statement.