Effect of ultra-low-dose transdermal estradiol on breast density in postmenopausal women

University of California Women's Health Clinical Research Center, San Francisco, CA 94115, USA.
Menopause (Impact Factor: 3.36). 05/2007; 14(3 Pt 1):391-6. DOI: 10.1097/01.gme.0000236939.81819.6c
Source: PubMed

ABSTRACT Women with higher mammographic breast density have increased risk for breast cancer, and there is some evidence that a change in breast density may be a marker for change in risk for breast cancer. The purpose of this study was to determine whether 2 years of treatment with ultra-low-dose transdermal estradiol results in a change in breast density.
The Ultra-Low-dose Transdermal Estradiol Assessment was a randomized, blinded, placebo-controlled trial of 2 years of treatment with unopposed ultra-low-dose (0.014 mg/d) transdermal estradiol for prevention of osteoporosis in 417 postmenopausal women with no history of breast cancer who had not had a hysterectomy. We obtained mammograms at baseline and after 1 and 2 years of treatment from 276 of the participants. Right craniocaudal views were analyzed at a central radiology facility by a trained clinician blinded to treatment group and order of acquisition. Contour analysis was performed to define dense areas versus fatty tissue. Between-group differences in mean change in percent breast density from baseline to 1 and to 2 years of follow-up were assessed using linear regression models adjusted for clinical site.
Participants were 66 +/- 5 years old and 94% were white. The average percent breast density at baseline was 34%. There was no significant difference between treatment groups in change in percent breast density after 1 year (between-group difference, 0.1%; 95% confidence interval, -1.3% to 1.6%) or 2 years of treatment (0.8%; -0.6% to 2.1%).
Two years of treatment with ultra-low-dose transdermal estradiol did not increase breast density.

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    • "mg oral conjugated equine estrogens (CEE) or 25–50 ␮g transdermal estradiol daily. There is evidence from observational data that lower estrogen dose may have a lesser impact on mammographic density [23] [24], stroke [25] and VTE [26] "
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    ABSTRACT: Obesity is a public health problem, with overweight individuals representing approximately 20% of the adult world population. Postmenopausal status is associated with higher prevalence of obesity, as 44% of postmenopausal women are overweight, among whom 23% are obese. Obesity often co-exists with other diseases, the most important being diabetes mellitus, dyslipidemia and hypertension. Furthermore, obesity increases the risk of gynecologic cancer, cardiovascular disease, venous thromboembolism, osteoarthritis and chronic back pain. To formulate a position statement on the management of the menopause in obese women. Literature review and consensus of expert opinion. Obese women seeking hormone therapy should be evaluated for their individual baseline risk of developing breast cancer, cardiovascular disease and venous thromboembolism. These risks should be weighed against expected benefit from symptom relief, improved quality of life and osteoporosis prevention. The lowest effective estrogen dose should be used (CEE 0.300-0.400 mg or estradiol 0.5-1 mg orally daily or 25-50 microg estradiol transdermally). With regard to progestogens, although no RCT data exist, there are observational studies showing that micronized progesterone or dydrogesterone may have a better risk profile with respect to breast cancer risk. There are no RCT data comparing various progestogens with regard to VTE risk. There are observational data, however, suggesting that micronized progesterone or pregnane derivatives may be associated with a lower VTE risk in postmenopausal women taking HT compared to nonpregnane derivatives. There is a rationale in suggesting the use of transdermal HT in obese women, since this route of administration has been associated with a lesser risk of venous thromboembolism than oral therapy.
    Maturitas 07/2010; 66(3):323-6. DOI:10.1016/j.maturitas.2010.03.025 · 2.94 Impact Factor
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    • "The ULTRA trial, which examined the effects of unopposed ultra-low-dose transdermal 17β-estradiol on BMD and biochemical markers of bone turnover in non-hysterectomized postmenopausal women, did not observe higher incidences of endometrial hyperplasia compared to the placebo group [39]. In addition, further examination of the ULTRA trial by Grady et al. [50] demonstrated that nonopposed ultra-low-dose transdermal 17β-estradiol does not significantly change breast density in postmenopausal women. Nielsen et al. [51] observed that similar to raloxifene, no significant change in breast density in osteopenic postmenopausal women with 2-year treatment with ultra-low-dose transdermal 17β-estradiol. "
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    ABSTRACT: The rapid decline in endogenous estrogen production that occurs during menopause is associated with significant bone loss and increased risk for fragility fracture. While hormone therapy (HT) is an effective means to re-establish endogenous estrogen levels and reduce the risk of future fracture, its use can be accompanied by undesirable side effects such as stroke and breast cancer. In this paper, we revisit the issue of whether HT can be both safe and effective for the prevention of postmenopausal bone loss by examining standard and alternative doses and formulations of HT. The aim of this paper is to continue the dialogue regarding the benefits and controversies of HT with the goal of encouraging the dissemination of-up-to date evidence that may influence how HT is viewed and prescribed.
    Journal of Osteoporosis 06/2010; 2010:708931. DOI:10.4061/2010/708931
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    ABSTRACT: Long time ago hormone therapy has had several indications during climacteric. However, after WHI study, its use has been reconsidered. According to several current consensus, hormone therapy must be prescribed to control vasomotor symptoms; low-doses are associated with lower risks than conventional doses. Multiple studies report benefits of low-dose and ultra low-dose of hormone therapy during cli - macteric. Here we review the literature on low and ultra low hormone therapy doses used in climacteric women, an alternative that must
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