Columbia University Medical Center, New York, NY
Parijatham S. Sivasubramanian , Katherine D. Crew , Kevin Kalinsky , Dawn L. Hershman , Matthew A. Maurer , Heather Greenlee , Laura L. Reimers , Mary Beth Terry
Background: Chemoprevention with antiestrogens, tamoxifen and raloxifene, is under-utilized partly due to concerns regarding side effects such as uterine cancer and thromboembolism. Tamoxifen is indicated for women with ductal and lobular carcinoma in situ (DCIS/LCIS) and has a favorable risk-benefit ratio for high-risk women under age 50. For women 50 years and older, a Risk Benefit Index (RBI) developed by Freedman et al. takes into account a woman's age, race, breast cancer risk, and prior hysterectomy. We examined the correlation between RBI and chemoprevention uptake among high-risk women. Methods: From 2007 to 2013, new high-risk women seen at an urban, academic breast clinic were enrolled. Eligibility for chemoprevention included a 5-yr Gail risk≥1.67%, DCIS/LCIS, or BRCA mutation. RBI scores for tamoxifen and raloxifene based upon published algorithm tables were calculated for high-risk women ≥50 yrs and classified as strong/moderate evidence of benefits outweighing risks and benefits do not outweigh risks. Women with DCIS/LCIS/BRCA mutation and age<50 were excluded from the analysis. Results: Among 403 women enrolled, 311 (77%) were eligible for chemoprevention. Among women with DCIS/LCIS/BRCA mutation and age<50, 62% (124/201) and 31% (10/32) took an antiestrogen, respectively. Among 60 women with an RBI score, 82% had strong/moderate benefit; 33% took an antiestrogen with 65% in agreement with their RBI score. Among women who did not take an antiestrogen, 80% would have had a benefit to raloxifene or both. Conclusions: Among high-risk women who took an antiestrogen, the majority of treatment decisions were in agreement with their RBI score. Most women who refused an antiestrogen would have benefited. High-risk postmenopausal women now have the option of aromatase inhibitors, which may improve the risk-benefit profile for chemoprevention.
Took tamoxifen |
Took raloxifene |
Took neither |
Total, N (%) |
|
---|---|---|---|---|
Strong/moderate benefit for both |
0 | 3 | 6 | 9 (15) |
Strong/moderate benefit for raloxifene |
4 | 9 | 26 | 39 (65) |
Strong/moderate benefit for tamoxifen | 1 | 0 | 0 | 1 (2) |
No benefit for both |
1 | 2 | 8 | 11 (18) |
Total, N (%) | 6 (10) | 14 (23) | 40 (67) | 60 (100) |
Disclaimer
This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org
Abstract Disclosures
2016 ASCO Annual Meeting
First Author: Haiyun Wang
2012 Breast Cancer Symposium
First Author: Constance Roche
2023 ASCO Annual Meeting
First Author: Takahiro Kogawa
2023 ASCO Annual Meeting
First Author: Sylvie Giacchetti