Multiple Breast Cancer Risk Factors Do Not Improve Patient Acceptance of Chemoprevention.

Abstract

Abstract Background: Patients may be at increased risk of developing breast cancer due to hereditary or familial risk or a pathological diagnosis of breast atypia or lobular carcinoma in situ (LCIS). Although tamoxifen and raloxifene are effective and approved chemopreventive agents to reduce risk of developing breast cancer in high risk individuals, acceptance of chemoprevention as a risk reduction strategy is low. Our objective was to assess whether chemoprevention is more readily accepted by those at genetic or familial risk versus pathologic risk, and if the presence of multiple breast cancer risk factors improves chemoprevention acceptance.Methods: All patients seen at the Loyola University Cancer Risk Assessment and Prevention clinic completed information including demographics, health, family and social history. Patients with a family history of either a first or second degree family member with breast cancer (FH) were compared to those who presented due to atypia or LCIS on breast biopsy as well as those with an elevated Gail score. Acceptance of risk reducing strategies between these groups was compared.Results: The initial 115 patients presenting to the clinic were analyzed. Thirty-six (31%) women had FH only, 26 (23%) had a biopsy with atypia or LCIS only, 10 (9%) had an elevated Gail score, 17 (15%) had a biopsy indicating atypia or LCIS plus FH, and 26 (23%) had an elevated Gail plus FH. Seventy-three patients were candidates for chemoprevention; 16 (22%) accepted chemoprevention. Patients with a FH plus atypia/LCIS did not accept chemoprevention more than patients with FH alone (p=1.00). Patients with a FH plus atypia/LCIS did not accept chemoprevention more than than patients with atypia/LCIS alone (p=0.451). Pts with elevated Gail plus FH did not accept chemoprevention more than patients with elevated Gail alone (p=0.144). Four women in the FH group were known BRCA mutation carriers; all elected to proceed with risk reducing surgery, none accepted chemoprevention.Conclusions: Acceptance of chemoprevention is low in women at genetic or familial risk, those at risk due to atypia/LCIS, and those with an elevated Gail score. Having both familial and pathologic risk factors for breast cancer development did not increase acceptance of chemoprevention. Better understanding of women's comprehension of breast cancer risk, and barriers to patient acceptance of chemoprevention are needed. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1039.