Adjuvant endocrine therapy non-initiation and non-persistence in young women with early-stage breast cancer

Breast Cancer Res Treat. 2023 Feb;197(3):547-558. doi: 10.1007/s10549-022-06810-1. Epub 2022 Nov 27.


Purpose: Characterizing oral adjuvant endocrine therapy (ET) non-initiation and non-persistence in young women with breast cancer can inform strategies to improve overall adherence in this population.

Methods: We identified 693 women with hormone receptor-positive, stage I-III breast cancer enrolled in a cohort of women diagnosed with breast cancer at age ≤ 40 years. Women were classified as non-initiators if they did not report taking ET in the 18 months after diagnosis. Women who initiated but did not report taking ET subsequently (through 5-year post-diagnosis) were categorized as non-persistent. We assessed ET decision-making and used logistic regression to identify factors associated with non-initiation/non-persistence and to evaluate the association between non-persistence and recurrence.

Results: By 18 months, 9% had not initiated ET. Black women had higher odds and women with a college degree had lower odds of non-initiation. Among 607 women who initiated, 20% were non-persistent. Younger age, being married/partnered, and reporting more weight problems were associated with higher odds of non-persistence; receipt of chemotherapy and greater hot flash and vaginal symptom burden were associated with lower odds of non-persistence. Adjusting for age and clinical characteristics, non-persistence was associated with lower odds of recurrence. Women who initiated were more likely to report shared decision-making than non-initiators (57% vs. 38%, p = 0.049), while women who were non-persistent were less likely to indicate high confidence with the decision than women who were persistent (40% vs. 63%, p < 0.001).

Conclusion: Interventions to improve ET decision-making may facilitate initiation and address barriers to adherence in young breast cancer survivors.

Trial registration: www.

Clinicaltrials: gov , NCT01468246.

Keywords: Adherence; Adjuvant endocrine therapy; Breast cancer; Non-initiation; Survivors.

Publication types

  • Clinical Trial

MeSH terms

  • Adjuvants, Immunologic / therapeutic use
  • Adult
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Breast Neoplasms* / drug therapy
  • Breast Neoplasms* / epidemiology
  • Cancer Survivors*
  • Chemotherapy, Adjuvant
  • Combined Modality Therapy
  • Female
  • Humans


  • Adjuvants, Immunologic
  • Antineoplastic Agents, Hormonal

Associated data