Physician and Patient Barriers to Breast Cancer Preventive Therapy

Hum, Susan; Wu, Mingfu; Pruthi, Sandhya; Heisey, Ruth

doi:10.1007/s12609-016-0216-5

Cited by 29 publications

(33 citation statements)

References 49 publications

(117 reference statements)

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“…52 Clinicians also need to be educated on risk/benefit counseling, since lack of physician knowledge has been cited as an important factor for low rates of chemoprevention uptake. 53,54 The American Society of Clinical Oncology guideline strongly recommends that chemoprevention should be discussed for women with a 5-year projected absolute risk of breast cancer of 1.66% or higher. 55 NCCN guidelines use the same threshold of a 5-year risk of 1.7% or higher, but adds that patients should have at least a life expectancy of 10 years or longer to be considered for preventive treatment.…”

Section: Map3 and Ibis-ii Performed Subgroup Analysis Of Women Withmentioning

confidence: 99%

Management of women at increased risk for breast cancer secondary to high‐risk proliferative lesions and family history of the disease

2020

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Women with breast biopsies showing high‐risk proliferative lesions such as atypical hyperplasia (AH) and lobular carcinoma in situ (LCIS) have an increased risk of developing breast cancer. Other factors including age, family history of breast cancer, and extent of AH may play a role in increasing breast cancer risk. In addition to women with AH, there is a subset of women with a positive family history of breast cancer, without a known germline mutation, which places them also at an increased risk for breast cancer. Clinical management, screening, chemoprevention, and surgical risk‐reduction are discussed in this review to inform the management of these high‐risk women. Advanced imaging technology, pharmacologic research into different targets, and innovations in breast reconstruction are changing the way in which patients are counseled of their individual risk.

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Section: Map3 and Ibis-ii Performed Subgroup Analysis Of Women Withmentioning

confidence: 99%

Management of women at increased risk for breast cancer secondary to high‐risk proliferative lesions and family history of the disease

2020

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“…The most commonly cited reasons by patients for declining preventive therapy are fear of side effects, including endometrial cancer, thromboembolic disease, and menopausal symptoms (22,23,28). Indeed, we found that concern about side effects was the primary reason for declining preventive therapy in addition to other previously reported barriers such as having an aversion to additional medications (29) and risk of breast cancer not perceived to be sufficiently high (30).…”

Section: Discussionmentioning

confidence: 57%

“…Barriers to prescribing preventive therapy that have been reported by primary care providers include lack of knowledge about preventive options, lack of time with patients, and lack of training in risk/benefit counseling (21)(22)(23). Paradoxically, risk/benefit counseling has been shown to reduce the uptake of preventive therapy (15) presumably by causing women to overestimate the risks of treatment (24).…”

Section: Discussionmentioning

confidence: 99%

A System-Level Approach to Improve the Uptake of Antiestrogen Preventive Therapy among Women with Atypical Hyperplasia and Lobular Cancer In Situ

Brewster

Thomas

Brown

et al. 2018

Cancer Prevention Research

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The low uptake of antiestrogen preventive therapy among women at high risk of developing breast cancer remains a challenge. We implemented a performance improvement program to increase the uptake of preventive therapy among women with atypical hyperplasia (AH) and lobular cancer (LCIS). A performance improvement program was implemented at the MD Anderson Cancer Center (Houston, TX), November 2015 to February 2017, for patients with a new (<6 months) or existing (≥6 months) diagnosis of AH/LCIS. The program consisted of an audit of eligible women who were recommended and prescribed preventive therapy and the provision of clinical performance feedback to providers. The baseline uptake of preventive therapy was estimated from patients enrolled in a high-risk breast cohort. Baseline uptake of preventive therapy was 44%. The program registered 408 patients with a new ( = 87) or existing diagnosis ( = 321) of AH/LCIS; mean age was 57 and 71% were non-Hispanic white. Ninety-eight percent of patients received a recommendation for preventive therapy. The overall prescribing of preventive therapy to patients with a new or existing diagnosis was 82% (monthly range, 40%-100%; = 0.76) and 48% (monthly range, 27%-57%; < 0.01), respectively. Adherence among patients with a new or existing diagnosis was 76% and 48% ( < 0.01) at 6 months, respectively. A system-level approach improved the uptake of preventive therapy. Identifying women at the time of diagnosis of AH/LCIS and offering a strong recommendation are key components for improving acceptance and adherence with preventive therapy. .

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“…Women without surgical excision who did not undergo a surgical consultation had significantly lower imaging adherence as well as chemoprevention uptake compared with their counterparts who underwent surgery, suggesting an important role for specialist care in these women with elevated risk. uptake rates in the literature (5%-15%) (36,37). In addition to unfavorable side-effect profiles of chemopreventive agents, a previously cited major barrier to implementation of chemoprevention was "lack of confidence in identifying high-risk patients" among nonspecialist care providers, with only 8% family physicians and 9% internists reporting ever having recommended or prescribed preventive therapy despite known risk factors (36).…”

Section: Discussionmentioning

confidence: 99%

“…uptake rates in the literature (5%-15%) (36,37). In addition to unfavorable side-effect profiles of chemopreventive agents, a previously cited major barrier to implementation of chemoprevention was "lack of confidence in identifying high-risk patients" among nonspecialist care providers, with only 8% family physicians and 9% internists reporting ever having recommended or prescribed preventive therapy despite known risk factors (36). In our study, the surgical group (ie, those who underwent surgical consultation) was significantly more likely to take up chemoprevention than the nonsurgical group, and all 21 women who chose chemoprevention had a surgical consultation, suggesting further value in breast specialist consultation for these women.…”

Section: Discussionmentioning

confidence: 99%

What Happens after a Diagnosis of High-Risk Breast Lesion at Stereotactic Vacuum-assisted Biopsy? An Observational Study of Postdiagnosis Management and Imaging Adherence

et al. 2018

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Purpose To assess adherence with annual or biennial screening mammography after a diagnosis of high-risk lesion(s) at stereotactic biopsy with or without surgical excision and to identify clinical factors that may affect screening adherence after a high-risk diagnosis. Materials and Methods This institutional review board-approved HIPAA-compliant retrospective study included 208 patients who underwent stereotactic biopsy between January 2012 and December 2014 that revealed a high-risk lesion. Whether the patient underwent surgical excision and/or follow-up mammography was documented. Adherence of these women to a protocol of subsequent mammography within 1 year (9-18 months) or within 2 years (9-30 months) was compared with that of 45 508 women with normal screening mammograms who were imaged during the same time period at the same institution. Possible factors relevant to postdiagnosis management and screening adherence were assessed. Consultation with a breast surgeon was identified by reviewing clinical notes. Uptake of pharmacologic chemoprevention following diagnosis (patient decision to take chemopreventive medications) was assessed. The Fisher exact test was used to compare annual or biennial screening adherence rates. Binary logistic regression was used to identify factors predictive of whether women returned for screening within selected time frames. Results In total, 913 (1.3%) of 67 874 women were given a recommendation to undergo stereotactic biopsy, resulting in diagnosis of 208 (22.8%) of 913 high-risk lesions. Excluding those with a prior personal history of breast cancer or upgrade to cancer at surgery, 124 (66.7%) of 186 women underwent surgery and 62 (33.3%) did not. Overall post-high-risk diagnosis adherence to annual or biennial mammography was similar to that in control subjects (annual, 56.4% vs 50.8%, P = .160; biennial, 62.0% vs 60.1%, P = .630). Adherence was significantly better in the surgical group than in the nonsurgical group for annual mammography (70.0% vs 32.0%; odds ratio [OR] = 5.0; 95% confidence interval [CI]: 2.4, 10.1; P < .001) and for biennial mammography (74.3% vs 40.0%; OR = 4.3; 95% CI: 2.1, 8.8; P < .001). Among the patients in the nonsurgical group, those adherent to annual or biennial mammography were significantly more likely to have seen a breast surgeon than the nonadherent women (annual, 77.3% vs 35.7%, P = .005; biennial, 67.9% vs 36.4%, P = .045). All patients receiving chemopreventive agents underwent a surgical consultation (100%; n = 21). Conclusion Although diagnosis of a high-risk lesion at stereotactic breast biopsy did not compromise overall adherence to subsequent mammographic screening, patients without surgical excision, particularly those who did not undergo a surgical consultation, had significantly lower imaging adherence and chemoprevention uptake as compared with their counterparts who underwent surgery, suggesting that specialist care may be important in optimizing management. RSNA, 2018.

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Physician and Patient Barriers to Breast Cancer Preventive Therapy

Cited by 29 publications

References 49 publications

Management of women at increased risk for breast cancer secondary to high‐risk proliferative lesions and family history of the disease

Management of women at increased risk for breast cancer secondary to high‐risk proliferative lesions and family history of the disease

A System-Level Approach to Improve the Uptake of Antiestrogen Preventive Therapy among Women with Atypical Hyperplasia and Lobular Cancer In Situ

What Happens after a Diagnosis of High-Risk Breast Lesion at Stereotactic Vacuum-assisted Biopsy? An Observational Study of Postdiagnosis Management and Imaging Adherence

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