Higher-Risk Women More Likely to Accept Breast Cancer Chemoprevention
Only a minority of women who are eligible for breast cancer chemoprevention will wind up using it, studies show, but new findings from a “high-risk” breast clinic suggest uptake could be higher if women receive adequate counseling.
“We found that about 50% of women would decide to go ahead and take a medication like this if they have all the information,” Dr. Richard Roetzheim of the University of South Florida in Tampa told Reuters Health. “We do need better medications, because about a third of the women who start up on a medication to reduce risk will end up stopping it because of side effects.”
Chemoprevention is recommended for all women with a five-year breast cancer risk of 1.7% or higher, Dr. Roetzheim and his team write in their report, published online December 6 in The Breast. But acceptance rates among eligible women are typically below 15%.
Tamoxifen was the first drug available for breast cancer prevention in higher-risk women, and other medications with fewer side effects have since become available. Treatment is typically recommended for a five-year period.
To better understand factors associated with acceptance and completion of chemoprevention among eligible women, Dr. Roetzheim and his colleagues looked at medical records for 219 women with a five-year breast cancer risk of 1.7% or higher treated at the H. Lee Moffitt Cancer Center & Research Institute. All were offered chemoprevention, and 54.4% agreed to begin therapy.
The higher a woman’s personal breast cancer risk, the more likely she was to accept chemoprevention, the researchers found. Women with high-risk conditions such as lobular carcinoma in situ and atypical ductal hyperplasia were also more likely to accept the therapy, as were women who drank alcohol and women with osteoporosis.
“For post-menopausal women, tamoxifen and raloxifene would be expected to provide additional benefit for osteoporosis which may have made these medications more attractive,” the authors note.
Fifty-eight (49.2%) of the women stopped taking their medication at least temporarily after they began, and an analysis of survival curves showed that about 60% of women could be expected to complete the full five years of therapy.
Part of the reason that acceptance of chemoprevention is so low, Dr. Roetzheim said, is likely because primary care physicians don’t have the time to identify eligible women in their practice, let alone inform them about the risks and benefits of treatment.
“The challenge for many physicians is figuring out who meets that 1.7% threshold,” he said. The National Cancer Institute offers a breast cancer assessment tool online, he added, but “unless a woman has done that individually, I don’t think that doctors have time to pull that up in their office and go over that with them.”
One possible approach to help identify eligible women, he added, would be to have patients complete the assessment tool when they go to have a mammogram. “I do think there are a large number of women who are eligible for these medications who would take them if they had adequate information,” he said
Another factor in the low acceptance of chemotherapy, according to Dr. Roetzheim, could be that tamoxifen’s side effects, which range from hot flashes to an increased risk of uterine cancer, have made patients and doctors wary, even though newer drugs have fewer side effects.
“Tamoxifen has some really scary side effects, and I think it kind of poisoned the well a bit in terms of the notion of giving drugs to prevent breast cancer,” the researcher said.
NEW YORK (Reuters Health) Breast 2014.