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Chemoprevention Uptake for Breast Cancer Risk Reduction Varies by Risk Factor

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background/Objective

The efficacy of chemoprevention for breast cancer risk reduction has been demonstrated in randomized controlled trials; however, use remains low. We sought to determine whether uptake differed by risk factors, and to identify reasons for refusal and termination.

Methods

Women seen in a high-risk clinic from October 2014 to June 2017 considered eligible for chemoprevention (history of lobular carcinoma in situ, atypia, family history of breast/ovarian cancer, genetic mutation, or history of chest wall radiation) were retrospectively identified. Breast cancer risk factors were compared among those with and without chemoprevention use, and compliance was noted.

Results

Overall, 1506 women were identified, 24% with prior/current chemoprevention use. Women ≥ 50 years of age were more likely to use chemoprevention than women < 50 years of age (28% vs. 11%, p < 0.001). Chemoprevention use by risk factor ranged from 7 to 40%. Having multiple risk factors did not increase use. Significant variation by risk factor was present among women ≥ 50 years of age (p < 0.001), but not among women < 50 years of age (p = 0.1). Among women with a documented discussion regarding chemoprevention (575/1141), fear of adverse effects was the most common refusal reason (57/156; 36%). The majority of women (61%) who initiated chemoprevention completed 5 years.

Conclusion

Chemoprevention use among women at increased risk for breast cancer remains low, with more frequent use among women ≥ 50 years of age. These data highlight the need for ongoing educational efforts and counseling, as the majority who begin therapy complete 5 years of use. Given the fear of adverse effects as well as low uptake, particularly among women < 50 years of age, alternative risk-reducing strategies are needed.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Meghan R. Flanagan MD, MPH, Michelle Stempel MPH, Debra A. Mangino DO, Monica Morrow MD & Melissa L. Pilewskie MD

  2. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Emily C. Zabor DrPH

Authors
  1. Meghan R. Flanagan MD, MPH
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  2. Emily C. Zabor DrPH
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  4. Debra A. Mangino DO
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  6. Melissa L. Pilewskie MD
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Correspondence to Melissa L. Pilewskie MD.

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Conflict of interest

Meghan R. Flanagan, Emily C. Zabor, Michelle Stempel, Debra A. Mangino, and Melissa L. Pilewskie have no conflict of interests to declare.

Disclosure

The preparation of this manuscript was funded in part by NIH/NCI Cancer Center Support Grant No. P30 CA008748 to Memorial Sloan Kettering Cancer Center. This study was presented in podium format at the 71st Society of Surgical Oncology Annual Cancer Symposium, Chicago, IL, USA, 21–24 March 2018. Dr. Monica Morrow has received honoraria from Roche and Genomic Health.

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Flanagan, M.R., Zabor, E.C., Stempel, M. et al. Chemoprevention Uptake for Breast Cancer Risk Reduction Varies by Risk Factor. Ann Surg Oncol 26, 2127–2135 (2019). https://doi.org/10.1245/s10434-019-07236-8

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  • DOI: https://doi.org/10.1245/s10434-019-07236-8

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