Addressing barriers to uptake of breast cancer chemoprevention for patients and providers

Am Soc Clin Oncol Educ Book. 2015;e50-8. doi: 10.14694/EdBook_AM.2015.35.e50.

Abstract

Breast cancer is the most common malignancy among women in the United States, and the primary prevention of this disease is a major public health issue. Because there are relatively few modifiable breast cancer risk factors, pharmacologic interventions with antiestrogens have the potential to significantly affect the primary prevention setting. Breast cancer chemoprevention with selective estrogen receptor modulators (SERMs) tamoxifen and raloxifene, and with aromatase inhibitors (AIs) exemestane and anastrozole, is underutilized despite several randomized controlled trials demonstrating up to a 50% to 65% relative risk reduction in breast cancer incidence among women at high risk. An estimated 10 million women in the United States meet high-risk criteria for breast cancer and are potentially eligible for chemoprevention, but less than 5% of women at high risk who are offered antiestrogens for primary prevention agree to take it. Reasons for low chemoprevention uptake include lack of routine breast cancer risk assessment in primary care, inadequate time for counseling, insufficient knowledge about antiestrogens among patients and providers, and concerns about side effects. Interventions designed to increase chemoprevention uptake, such as decision aids and incorporating breast cancer risk assessment into clinical practice, have met with limited success. Clinicians can help women make informed decisions about chemoprevention by effectively communicating breast cancer risk and enhancing knowledge about the risks and benefits of antiestrogens. Widespread adoption of chemoprevention will require a major paradigm shift in clinical practice for primary care providers (PCPs). However, enhancing uptake and adherence to breast cancer chemoprevention holds promise for reducing the public health burden of this disease.

MeSH terms

  • Antineoplastic Agents / therapeutic use*
  • Aromatase Inhibitors / therapeutic use
  • Breast Neoplasms / prevention & control*
  • Female
  • Health Personnel
  • Humans
  • Practice Patterns, Physicians'
  • Risk Assessment
  • Selective Estrogen Receptor Modulators / therapeutic use

Substances

  • Antineoplastic Agents
  • Aromatase Inhibitors
  • Selective Estrogen Receptor Modulators