Use and cost of breast imaging for postmenopausal women undergoing hormone replacement therapy

The purpose of this study was to evaluate the use and associated costs of breast imaging studies for postmenopausal women undergoing hormone replacement therapy (HRT).

Clinical findings, mammographic findings, and imaging studies performed on 1133 postmenopausal women during a 5-month period in 1996 were retrospectively reviewed. Cost was estimated using Medicare reimbursement rates.

Of the 1133 women, 699 (62%) underwent HRT. The number of women with breast complaints was similar for those undergoing (n = 62, 9%) and not undergoing (n = 26, 6%) HRT. Benign findings were more common for women undergoing HRT (n = 186, 27%) than for women not undergoing HRT (n = 92, 21%) (p = .04). Masses were noted in 133 of the women undergoing HRT (19%), compared with 42 women not undergoing HRT (10%) (p < .000). Specifically, cysts were seen in 46 women undergoing HRT (7%), compared with five women not undergoing HRT (1%) (p < .0001). Diagnostic mammograms and sonograms were more commonly obtained in women undergoing HRT (33 and 13 per 100 women, respectively) than in women not undergoing HRT (24 and seven per 100, respectively) (p = .014 and .0007, respectively). The overall cost of breast imaging was $89 for each woman undergoing HRT and $87 for each woman not undergoing HRT.

Benign mammographic findings, primarily cysts, in women undergoing HRT result in an increased use of diagnostic mammography and sonography. The minimal increase in cost should not be a significant factor in the decision to use HRT.