BACKGROUND

Large clinical trials have proven the efficacy of selective estrogen receptor modulators in reducing the risk of breast cancer in high risk women. However, despite these studies the use of chemoprevention in high risk women remains low. The goal of this study was to determine in a clearly identified high risk population, the utilization rate of chemoprevention and factors that affect its use, notably, surgeon training and the Gail model.

METHODS

This was a retrospective chart review of all women diagnosed with Atypical Ductal Hyperplasia (ADH) at our institution from 2008 to 2013. We examined the use of chemoprevention and screening recommendations after diagnosis. Other factors evaluated included family history, Gail model, surgeon specialty and menopausal status.

RESULTS

Ninety-four women with ADH were treated at our facility in the study time frame. The overall use of chemoprevention in our study population was 41.5%. Of those who were not on chemoprevention, 56.4 % were offered chemoprevention and declined. In addition, after the diagnosis of ADH, annual mammography was recommended for 75% of women. However, this was preferentially seen in women on chemoprevention (95% vs. 65%). Menopausal status and use of the Gail model were statistically significant in predicting annual screening after a diagnosis of ADH. The Gail score was calculated preferentially in women who chose chemoprevention. Prior breast biopsy, family history of cancer, first degree relative with cancer, age and menopausal status were not found to be statistically significant in the use of chemoprevention. Oncology training and use of the Gail model were found to be statistically significant in chemoprevention use.

CONCLUSION

The use of chemoprevention in high risk women is significantly improved with oncology training and the use of the Gail model. Concern regarding side effects continues to result in low utilization of selective estrogen receptor modulators. Education regarding newer agents for chemoprevention with minimal side effects may result in increased utilization of chemoprevention.

Table 1: Patient Characteristics

Factors Chemoprevention n (%) No Chemoprevention n (%) p value 
Median age (range) 58 (37-78) 52 (30-77) 0.07 
Race     0.790 
Caucasian 18 (46.1 %) 33 (60.0 %)   
Asian/PCI 6 (15.4 %) 5 (9.1 %)   
African American 2 (5.1 %) 2 (3.6 %)   
Hispanic 2 (5.1 %) 1 (1.8 %)   
Family history 10 (25.6 %) 18 (32.7 %) 0.358 
First degree 26 (66.7 %) 32 (58.1 %) 1.000 
Gail score calculated 29 (74.3 %) 20 (36.3 %) <0.001 
Gail score median (range) 3.4 % (0.8-17.7) 2.7% (0.2-8.6) 0.169 
Menopausal status 17 (43.6 %) 19 (34.5 %) 0.796 
Specialty provider 37 (94.9 %) 38 (69.1 %) 0.002 
Prior breast biopsy 13 (33.3 %) 16 (29.1 %) 0.438 
Factors Chemoprevention n (%) No Chemoprevention n (%) p value 
Median age (range) 58 (37-78) 52 (30-77) 0.07 
Race     0.790 
Caucasian 18 (46.1 %) 33 (60.0 %)   
Asian/PCI 6 (15.4 %) 5 (9.1 %)   
African American 2 (5.1 %) 2 (3.6 %)   
Hispanic 2 (5.1 %) 1 (1.8 %)   
Family history 10 (25.6 %) 18 (32.7 %) 0.358 
First degree 26 (66.7 %) 32 (58.1 %) 1.000 
Gail score calculated 29 (74.3 %) 20 (36.3 %) <0.001 
Gail score median (range) 3.4 % (0.8-17.7) 2.7% (0.2-8.6) 0.169 
Menopausal status 17 (43.6 %) 19 (34.5 %) 0.796 
Specialty provider 37 (94.9 %) 38 (69.1 %) 0.002 
Prior breast biopsy 13 (33.3 %) 16 (29.1 %) 0.438 
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The views expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

Citation Format: Oseni T, Perkins S, Deutsch E, Soballe P. The use of chemoprevention increases significantly with oncology trained providers and with application of a risk assessment model. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-08-05.