Atypia in Random Periareolar Fine-Needle Aspiration Affects the Decision of Women at High Risk to Take Tamoxifen for Breast Cancer Chemoprevention

Goldenberg, Vanessa; Seewaldt, Victoria L.; Scott, Victoria; Bean, Gregory R.; Broadwater, Gloria; Fabian, Carol J.; Kimler, Bruce F.; Zalles, Carola M.; Lipkus, Isaac M.

doi:10.1158/1055-9965.epi-06-0910

Cited by 23 publications

(17 citation statements)

References 24 publications

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“…However, that is not to say that opinions remain static. In the study of Goldenberg et al (2007), 99 women at high risk who had already declined to take tamoxifen underwent random peri-areolar fine needle aspiration. After the result, 51 out of 99 (51.5%) had a normal cells detected and none of these wished to take tamoxifen.…”

Section: Discussionmentioning

confidence: 99%

Uptake of tamoxifen in consecutive premenopausal women under surveillance in a high-risk breast cancer clinic

Donnelly¹,

Evans

Wiseman³

et al. 2014

Br J Cancer

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Background:Randomised trials of tamoxifen versus placebo indicate that tamoxifen reduces breast cancer risk by approximately 33%, yet uptake is low. Approximately 10% of women in our clinic entered the IBIS-I prevention trial. We assess the uptake of tamoxifen in a consecutive series of premenopausal women not in a trial and explore the reasons for uptake through interviews.Methods:All eligible women between 33 and 46 years at ⩾17% lifetime risk of breast cancer and undergoing annual mammography in our service were invited to take a 5-year course of tamoxifen. Reasons for accepting (n=15) or declining (n=15) were explored using semi-structured interviews.Results:Of 1279 eligible women, 136 (10.6%) decided to take tamoxifen. Women >40 years (74 out of 553 (13.4%)) and those at higher non-BRCA-associated risk were more likely to accept tamoxifen (129 out of 1109 (11.6%)). Interviews highlighted four themes surrounding decision making: perceived impact of side effects, the impact of others' experience on beliefs about tamoxifen, tamoxifen as a ‘cancer drug', and daily reminder of cancer risk.Conclusions:Tamoxifen uptake was similar to previously ascertained uptake in a randomised controlled trial (IBIS-I). Concerns were similar in women who did or did not accept tamoxifen. Decision making appeared to be embedded in the experience of significant others.

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Section: Discussionmentioning

confidence: 99%

Uptake of tamoxifen in consecutive premenopausal women under surveillance in a high-risk breast cancer clinic

Donnelly¹,

Evans

Wiseman³

et al. 2014

Br J Cancer

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“…20 Other studies conducted in similar settings reported that about 50% of women accept an offer to begin tamoxifen. 21, 22 Uptake of tamoxifen in the setting of clinical trials, however, has been lower, ranging from 5–14%. 23, 24 …”

Section: Discussionmentioning

confidence: 99%

Acceptance and adherence to chemoprevention among women at increased risk of breast cancer

et al. 2015

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Background Chemoprevention is an option for women who are at increased risk of breast cancer (five year risk ≥1.7%). It is uncertain, however, how often women accept and complete five years of therapy and whether clinical or demographic factors predict completion. Methods Medical records were abstracted for 219 women whose five year risk of breast cancer was ≥ 1.7% and who were offered chemoprevention while attending a high risk breast clinic at the Moffitt Cancer Center. We examined the likelihood of accepting chemoprevention and completing five years of therapy, and potential clinical and demographic predictors of these outcomes, using multivariable logistic regression and survival analysis models. Results There were 118/219 women (54.4%) who accepted a recommendation for chemoprevention and began therapy. The likelihood of accepting chemoprevention was associated with lifetime breast cancer risk and was higher for women with specific high risk conditions (lobular carcinoma in situ and atypical ductal hyperplasia). Women with osteoporosis and those that consumed alcohol were also more likely to accept medication. There were 58/118 (49.2%) women who stopped medication at least temporarily after starting therapy. Based on survival curves, an estimated 60% of women who begin chemoprevention will complete five years of therapy. Conclusions A substantial percentage of women at increased risk of breast cancer will decline chemoprevention and among those that accept therapy, approximately 40% will not be able to complete five years of therapy because of side effects.

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“…However, studies that involved consultation at a specialized breast center reported SERM use ranging from 11% to 58% [36, 40, 41, 50, 61, 62]. Variation in SERM uptake may have been due to the strength of the physician’s recommendation [63].…”

Section: Interventions To Increase Uptake Of Breast Cancer Chemoprevementioning

confidence: 99%

Tamoxifen versus Raloxifene versus Exemestane for Chemoprevention

Reimers

Crew

2012

Curr Breast Cancer Rep

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Clinical trial data on selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) have demonstrated reduced breast cancer incidence in the prevention setting among high-risk women. We conducted an extensive review of clinical trials and recent published reports of barriers to uptake of breast cancer chemoprevention, to provide health care professionals with information to improve decision-making regarding chemoprevention. Despite the positive results of these trials, uptake of chemoprevention has been low due to barriers in identifying high-risk women, lack of understanding of risks and benefits, as well as concerns about side effects. Interventions designed to increase uptake have met with limited success. Clinicians can support women in informed decision-making about SERMs and AIs by effectively communicating breast cancer risk and enhancing knowledge about the risks and benefits of chemoprevention. Promoting uptake and adherence to chemoprevention holds promise for reducing the public health burden of this disease.

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Atypia in Random Periareolar Fine-Needle Aspiration Affects the Decision of Women at High Risk to Take Tamoxifen for Breast Cancer Chemoprevention

Cited by 23 publications

References 24 publications

Uptake of tamoxifen in consecutive premenopausal women under surveillance in a high-risk breast cancer clinic

Uptake of tamoxifen in consecutive premenopausal women under surveillance in a high-risk breast cancer clinic

Acceptance and adherence to chemoprevention among women at increased risk of breast cancer

Tamoxifen versus Raloxifene versus Exemestane for Chemoprevention

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