Highlights
- •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
Abstract
Purpose
Evaluate the longitudinal relationship between mammographic density and hormonal contraceptive
use in late reproductive-aged women.
Methods
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.
Results
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.
Conclusion(s)
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.
Keywords
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Article info
Publication history
Published online: March 06, 2023
Accepted:
March 1,
2023
Received in revised form:
February 25,
2023
Received:
August 15,
2022
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
