Use of the Gail Model and Breast Cancer Preventive Therapy Among Three Primary Care Specialties

Corbelli, Jennifer; Borrero, Sonya; Bonnema, Rachel; McNamara, Megan; Kraemer, Kevin L.; Rubio, Doris M.; Karpov, Irina; McNeil, Melissa

doi:10.1089/jwh.2014.4742

Cited by 50 publications

(54 citation statements)

References 34 publications

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“…A cross-sectional, web-based survey of physicians [16] revealed that only 13 % of providers had recommended or prescribed preventive therapy (8 % family medicine, 9 % internal medicine, 30 % gynecology).…”

Section: Physicians’ Barriersmentioning

confidence: 99%

“…Most PCPs have never used the Gail model [20], which is currently the best available tool to identify suitable candidates for preventive therapy [16, 17]. In a cross-sectional survey of 300 PCPs, only 37 and 33 % of internists and family physicians, respectively, reported ever using the Gail model, as compared to 60 % of gynecologists [16]. …”

Section: Physicians’ Barriersmentioning

confidence: 99%

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Physician and Patient Barriers to Breast Cancer Preventive Therapy

Hum

Pruthi

et al. 2016

Curr Breast Cancer Rep

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The uptake of selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) for the primary prevention of breast cancer is low, despite their proven efficacy in several randomized clinical trials. This review summarizes the latest data on physicians’ and women’s barriers to breast cancer preventive therapy. Physicians’ challenges include: identifying suitable candidates for preventive therapy, inadequate training and confidence in risk assessment and counselling, insufficient knowledge of risk-reducing medications, and lack of time. High-risk women fear medication side effects, and they often weigh experiences of others more heavily than statistical probabilities to guide their decision-making. Despite decision aid interventions to help women make an informed decision, acceptance of preventive therapy will remain low until: risk/benefit profiles are more favorable, physicians are better educated and skilled in having these discussions, and suitable biomarkers to monitor drug efficacy and better clinical risk prediction models to assess true individual risk are available.

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Section: Physicians’ Barriersmentioning

confidence: 99%

Section: Physicians’ Barriersmentioning

confidence: 99%

Physician and Patient Barriers to Breast Cancer Preventive Therapy

Hum

Pruthi

et al. 2016

Curr Breast Cancer Rep

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“…However, only 40% of primary care providers (n ¼ 316) in a recent cross-sectional, web-based survey reported using the Gail model to assess breast cancer risk and even fewer (13%) reported recommending or prescribing chemoprevention medications (Corbelli et al, 2014); a lack of provider familiarity with both risk assessment and the benefits and risks or chemoprevention options were identified as barriers to chemoprevention uptake (Corbelli et al, 2014;Reimers & Crew, 2012). Continuing education to enhance provider skill evaluating and in communicating information about risk to patients as well as awareness of and comfort prescribing chemoprevention medications is therefore of paramount importance.…”

Section: Implications For Practice And/or Policymentioning

confidence: 99%

“…Characteristics of Mammography Patients Reporting Female and Male versusMale-Only Sexual Partners, 2013-2014 …”

mentioning

confidence: 99%

Breast Cancer Risk in Sexual Minority Women during Routine Screening at an Urban LGBT Health Center

Clavelle

King

Bazzi

et al. 2015

Women's Health Issues

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“…82 Different medical specialties vary widely in their use of the Gail model (33–37% for internal medicine and family medicine compared to 60% for gynecology) and ever prescribing anti-estrogens (8–9% for internal medicine and family medicine compared to 30% for gynecology). 83 Additional barriers to routine breast cancer risk assessment include time constraints, lack of familiarity and comfort prescribing preventive therapy. 84 Physician recommendation and effective communication strongly influence uptake of preventive therapy for breast cancer.…”

Section: Introductionmentioning

confidence: 99%

How do we increase uptake of tamoxifen and other anti-estrogens for breast cancer prevention?

et al. 2017

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Several randomized controlled trials of anti-estrogens, such as tamoxifen and aromatase inhibitors, have demonstrated up to a 50–65% decrease in breast cancerincidence among high-risk women. Approximately 15% of women, age 35–79 years, in the U.S. meet criteria for breast cancer preventive therapies, but uptake of these medications remain low. Explanations for this low uptake includelack of awareness of breast cancer risk status, insufficient knowledge about breast cancer preventive therapies among patients and physicians, and toxicity concerns. Increasing acceptance of pharmacologic breast cancer prevention will require effective communication of breast cancer risk, accurate representation about the potential benefits and side effects of anti-estrogens, targeting-specific high-risk populations most likely to benefit from preventive therapy, and minimizing the side effects of current anti-estrogens with novel administration and dosing options. One strategy to improve the uptake of chemoprevention strategies is to consider lessons learned from the use of drugs to prevent other chronic conditions, such as cardiovascular disease. Enhancing uptake and adherence to anti-estrogens for primary prevention holds promise for significantly reducing breast cancer incidence, however, this will require a significant change in our current clinical practice and stronger advocacy and awareness at the national level.

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Use of the Gail Model and Breast Cancer Preventive Therapy Among Three Primary Care Specialties

Cited by 50 publications

References 34 publications

Physician and Patient Barriers to Breast Cancer Preventive Therapy

Physician and Patient Barriers to Breast Cancer Preventive Therapy

Breast Cancer Risk in Sexual Minority Women during Routine Screening at an Urban LGBT Health Center

How do we increase uptake of tamoxifen and other anti-estrogens for breast cancer prevention?

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