Less mammographic density after nasal versus oral administration of postmenopausal hormone therapy

ABSTRACT

Objective Nasal administration gives a more acute but shorter rise in serum hormone levels than oral administration and may therefore have less effect on the fibroglandular tissue in the breasts. We studied the change in mammographic breast density after nasal vs. oral administration of postmenopausal hormone therapy (PHT).

Methods We studied participants in a randomized, controlled trial on the impact of nasal vs. oral administration of PHT (combined 17β-estradiol plus norethisterone) for 1 year. Two radiologists classified mammographic density at baseline and after 1 year into four categories. Also, the percentage density was calculated by a computer-based method. The main outcome measure was the difference in the proportion of women with an increase in mammographic density category after 1 year between the nasal and oral groups. Also, the change in the percentage density was calculated.

Results The study group comprised 112 healthy postmenopausal women (mean age 56 years), of whom 53 received oral and 59 intranasal PHT. An increase in mammographic density category after 1 year was seen in 20% of the women in the nasal group and in 34% of the oral group. This resulted in a non-significant difference in the proportion of women in whom mammographic breast density had increased by 214% (95% confidence interval (CI) 230% to 2.7%). The mean change in percentage density was 21.2% in the nasal group and + 1.2% in the oral group, yielding a 22.4% differential effect (95% CI 27.3% to 2.5%).

Conclusions One year of nasal PHT gave a smaller, although not statistically significant, increase in mammographic density than oral PHT. Remaining issues are the relation between the route of administration of PHT and breast complaints and breast cancer risk.

Key words::

• BREAST DENSITY
• MAMMOGRAPHIC DENSITY
• POSTMENOPAUSAL HORMONE THERAPY
• ADMINISTRATION
• ORAL
• NASAL

ACKNOWLEDGEMENTS

We acknowledge the radiologists A. H. M. Taets van Amerongen, F. van der Horst and J. H. C. L. Hendriks, who died in 2004, for scoring the mammograms. Further, we thank W. Lemmens and P. van de Looi at the Netherlands Reference and Training Center for Breast Cancer Screening (LRCB) for their support.

Conflict of interest The authors report no conflict of interest. The authors alone are responsible for the content and writing of this paper.

Source of funding This study was supported by a research grant from the Institut de Recherches Internationales Servier to the Biocare Foundation (grant no. 01-049).