Introduction:Estrogen agonists/ antagonists (Selective Estrogen Receptor Modulators, SERMS) are a class of medications, which are gaining popularity in menopause health care as they can effectively address a variety of symptoms and offer a non-hormonal alternative. In particular, bone and genitourinary health both suffer from the ramifications of menopause as well as breast cancer treatment. Chemoprevention is also a medical concern in the at risk population. Breast chemoprevention efficacy, and prevention and treatment of osteoporosis as well as improvement of vulvovaginal health are dependent on estrogen receptor activity in the menopause and would be useful targets for treatment of menopausal women, for breast cancer patients and those with genetic predisposition to cancer syndromes who may undergo prophylactic surgeries or face decades of premature menopause and hypoestrogenism. To understand clinician awareness, we conducted an online internet survey to assess the current treatment practices for the use of SERMS for postmenopausal patients, specifically concerning the symptoms of osteoporosis/ osteopenia and vulvovaginal atrophy (VVA). Methods: A self- administered Internet survey was conducted for physicians who were potential prescribes of SERMS. One hundred and eight (n=108) physicians were included (OBGYN n= 53; PCP n= 55). The eligibility criteria included: Primary specialty of OB/GYN or Gynecology for “OB/GYNs,” Family Practice, General Practice or Internal Medicine. Physician participants had at least two and not more than 30 years of practice experience. Clinicians were currently in a community-based practice and were known to treat a minimum number of postmenopausal patients per month for both osteopenia/osteoporosis and vulvovaginal atrophy (VVA) Results: Physicians in this study saw an average of 100-250 postmenopausal patients per month. Although not statistically significant, OB/GYNs reported a higher monthly average volume of postmenopausal patients (186 patients) versus PCPs (140 patients.) SERMs were prescribed on average for a small percentage of patients though physicians anticipated that this would increase in the future. Nearly half of the physicians (48%) reported that the number of their postmenopausal patients who are receiving prescriptions for medications for prevention of osteoporosis is increasing. A novel SERM under investigation, had features perceived as uniquely favorable by a large majority of clinicians and included: Reducing vertebral fracture by 42% and non-vertebral fracture by 26% (76%), and 80% reduction in incidence of ER+ breast cancers at 5 years (74%), no significant drug-drug interactions (72%), and supported by a 5-year placebo-controlled study (70%). Conclusions: Clinicians are aware of the class of SERMS, use is likely to increase and agree that they may be of therapeutic benefit for menopausal women that have multiple post-menopausal health issues. There was recognition of a triad of concerns and the need for concomitant breast cancer chemoprevention, VVA improvement, and maintenance of bone health. Agents that target the estrogen receptor selectively may meet the goals of many clinicians in at-risk patient populations.
Citation Format: Krychman M, Portman D. Physicians perceptions of estrogen agonist/antagonists in menopausal health: An opportunity to address a triad of concerns in menopause and breast cancer survivorship [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-14.