Breast Imaging| Volume 97, P62-67, May 2023

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Effect of contraceptive hormonal therapy on mammographic breast density: A longitudinal cohort study


      • Women aged 35-50 years undergoing screening mammography were categorized by contraceptive exposure during a 2-year lead-in and 7.5-year study period
      • Long-term use of combined oral contraceptives or a levonorgestrel intrauterine device was not associated with an increase in breast density category
      • Initiation of combined oral contraceptives was associated with an increase in breast density category
      • There was no difference in initial breast density in patients exposed to combined oral contraceptives over the lead-in period vs those not exposed
      • Discontinuation of combined oral contraceptives was not associated with a decrease in breast density category



      Evaluate the longitudinal relationship between mammographic density and hormonal contraceptive use in late reproductive-aged women.


      Patients aged 35–50 years old who underwent 5 or more screening mammograms within a 7.5-year period between 2004 and 2019 in a single urban tertiary care center were randomly selected. Patients were categorized into four cohorts based on hormonal contraceptive exposure during a 2-year lead-in period and a 7.5-year study period: 1) never exposed, 2) always exposed, 3) interval hormonal contraceptive start, and 4) interval hormonal contraceptive stop. The primary outcome was difference in BI-RADS breast density category between initial and final mammograms.


      Of the 708 patients included, long-term use of combined oral contraceptives or a levonorgestrel intrauterine device were not associated with an increase in breast density category over the 7.5-year study period, compared to those with no hormonal contraceptive exposure. Initiation of combined oral contraceptives was associated with an increase in breast density category (β = 0.31, P = 0.045); however, no difference in initial density category was noted between those exposed and those never exposed to combined oral contraceptives during the 2-year lead-in period, and discontinuation was not associated with a decrease in breast density category when compared to those with continuous exposure.


      Long-term use of combined oral contraceptives or a levonorgestrel intrauterine device was not associated with an increase in BI-RADS breast density category. Initiation of a combined oral contraceptive was associated with an increase in breast density category, although this may be a transient effect.


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