Chemoprevention Uptake for Breast Cancer Risk Reduction Varies by Risk Factor.

Abstract

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. 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. Overall, 1506 women were identified, 24% with prior/current chemoprevention use. Women ≥ 50years of age were more likely to use chemoprevention than women < 50years 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 ≥ 50years of age (p < 0.001), but not among women < 50years 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 5years. Chemoprevention use among women at increased risk for breast cancer remains low, with more frequent use among women ≥ 50years of age. These data highlight the need for ongoing educational efforts and counseling, as the majority who begin therapy complete 5years of use. Given the fear of adverse effects as well as low uptake, particularly among women < 50years of age, alternative risk-reducing strategies are needed.