Breast Cancer Chemoprevention: A Practical Guide for the Primary Care Provider

Farkas, Amy; Vanderberg, Rachel; Merriam, Sarah; DiNardo, Deborah

doi:10.1089/jwh.2018.7643

Cited by 12 publications

(11 citation statements)

References 65 publications

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“…High-risk criteria for breast cancer are defined as a 5-year invasive breast cancer risk of ≥1.67% or lifetime risk score of ≥20% according to the Gail risk model, which accounts for age, race and ethnicity, benign breast disease, first-degree family history of breast cancer, and reproductive factors [ 4 , 5 ]. Chemopreventive agents such as selective estrogen receptor modulators (tamoxifen and raloxifene) and aromatase inhibitors (exemestane and anastrozole) have been shown to reduce breast cancer risk by 41%-79% among high-risk women [ 6 ]. Despite the risk-reducing benefits, chemoprevention uptake remains low in the United States, with fewer than 5% of high-risk women deciding to take the medication [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Perceptions of Racially and Ethnically Diverse Women at High Risk of Breast Cancer Regarding the Use of a Web-Based Decision Aid for Chemoprevention: Qualitative Study Nested Within a Randomized Controlled Trial

Jones¹,

Guzman²,

Silverman³

et al. 2021

J Med Internet Res

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Background Chemopreventive agents such as selective estrogen receptor modulators and aromatase inhibitors have proven efficacy in reducing breast cancer risk by 41% to 79% in high-risk women. Women at high risk of developing breast cancer face the complex decision of whether to take selective estrogen receptor modulators or aromatase inhibitors for breast cancer chemoprevention. RealRisks is a patient-centered, web-based decision aid (DA) designed to promote the understanding of breast cancer risk and to engage diverse women in planning a preference-sensitive course of decision making about taking chemoprevention. Objective This study aims to understand the perceptions of women at high risk of developing breast cancer regarding their experience with using RealRisks—a DA designed to promote the uptake of breast cancer chemoprevention—and to understand their information needs. Methods We completed enrollment to a randomized controlled trial among 300 racially and ethnically diverse women at high risk of breast cancer who were assigned to standard educational materials alone or such materials in combination with RealRisks. We conducted semistructured interviews with a subset of 21 high-risk women enrolled in the intervention arm of the randomized controlled trial who initially accessed the tool (on average, 1 year earlier) to understand how they interacted with the tool. All interviews were audio recorded, transcribed verbatim, and compared with digital audio recordings to ensure the accuracy of the content. We used content analysis to generate themes. Results The mean age of the 21 participants was 58.5 (SD 10.1) years. The participants were 5% (1/21) Asian, 24% (5/21) Black or African American, and 71% (15/21) White; 10% (2/21) of participants were Hispanic or Latina. All participants reported using RealRisks after being granted access to the DA. In total, 4 overarching themes emerged from the qualitative analyses: the acceptability of the intervention, specifically endorsed elements of the DA, recommendations for improvements, and information needs. All women found RealRisks to be acceptable and considered it to be helpful (21/21, 100%). Most women (13/21, 62%) reported that RealRisks was easy to navigate, user-friendly, and easily accessible on the web. The majority of women (18/21, 86%) felt that RealRisks improved their knowledge about breast cancer risk and chemoprevention options and that RealRisks informed their (17/21, 81%) decision about whether or not to take chemoprevention. Some women (9/21, 43%) shared recommendations for improvements, as they wanted more tailoring based on user characteristics, felt that the DA was targeting a narrow population of Hispanic or Latina by using graphic novel–style narratives, wanted more understandable terminology, and felt that the tool placed a strong emphasis on chemoprevention drugs. Conclusions This qualitative study demonstrated the acceptability of the RealRisks web-based DA among a diverse group of high-risk women, who provided some recommendations for improvement.

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Section: Introductionmentioning

confidence: 99%

Perceptions of Racially and Ethnically Diverse Women at High Risk of Breast Cancer Regarding the Use of a Web-Based Decision Aid for Chemoprevention: Qualitative Study Nested Within a Randomized Controlled Trial

Jones¹,

Guzman²,

Silverman³

et al. 2021

J Med Internet Res

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“…The risk assessment process (see [4][5][6][7][8][9] ). These factors include having a history of chest radiation between the ages of 10 and 30, a history of breast biopsy with either lobular carcinoma in situ (LCIS) or atypical ductal hyperplasia (ADH), past breast and/or ovarian cancer, and either a family or personal history of a high penetrant genetic variant for breast cancer.…”

Section: Risk Assessmentmentioning

confidence: 99%

“…These factors include having a history of chest radiation between the ages of 10 and 30, a history of breast biopsy with either lobular carcinoma in situ (LCIS) or atypical ductal hyperplasia (ADH), past breast and/or ovarian cancer, and either a family or personal history of a high penetrant genetic variant for breast cancer. [4][5][6][7][8][9] In women with previous chest radiation, breast cancer risk correlates with the total dose of radiation. 5 For women with a personal history of breast cancer, the younger the age at diagnosis, the higher the risk of contralateral breast cancer.…”

Section: Risk Assessmentmentioning

confidence: 99%

How to better identify and manage women with elevated breast cancer risk

Schrager¹

2022

The Journal of Family Practice

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PRACTICE RECOMMENDATIONS❯ Assess breast cancer risk in all women starting at age 35. C ❯ Perform enhanced screening in all women with a lifetime risk of breast cancer > 20%. A ❯ Discuss chemoprevention for all women at elevated risk for breast cancer. B How to better identify and manage women with elevated breast cancer risk This case-based review details screening and management strategies that can maximize the care you provide to women at heightened risk.

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“…As an example, the US Food and Drug Administration recommended to consider chemoprevention for women at high risk of breast cancer (ie, a 5-year risk equal or higher than 1.66%), while the US Preventive Services Task Force recommended chemoprevention for a risk equal or higher than 3%. 8 The Canadian Task Force, as well as the Canadian Cancer Society, used a threshold of 1.66%. 9 10 Despite its implementation on the NCI's website ( bcrisktool.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Validation of breast cancer risk assessment tools on a French-Canadian population-based cohort

et al. 2021

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ObjectivesEvaluate the accuracy of the Breast Cancer Risk Assessment Tool (BCRAT), International Breast Cancer Intervention Study risk evaluation tool (IBIS), Polygenic Risk Scores (PRS) and combined scores (BCRAT+PRS and IBIS +PRS) to predict the occurrence of invasive breast cancers at 5 years in a French-Canadian population.DesignPopulation-based cohort study.SettingWe used the population-based cohort CARTaGENE, composed of 43 037 Quebec residents aged between 40 and 69 years and broadly representative of the population recorded on the Quebec administrative health insurance registries.Participants10 200 women recruited in 2009–2010 were included for validating BCRAT and IBIS and 4555 with genetic information for validating the PRS and combined scores.Outcome measuresWe computed the absolute risks of breast cancer at 5 years using BCRAT, IBIS, four published PRS and combined models. We reported the overall calibration performance, goodness-of-fit test and discriminatory accuracy.Results131 (1.28%) women developed a breast cancer at 5 years for validating BCRAT and IBIS and 58 (1.27%) for validating PRS and combined scores. Median follow-up was 5 years. BCRAT and IBIS had an overall expected-to-observed ratio of 1.01 (0.85–1.19) and 1.02 (0.86–1.21) but with significant differences when partitioning by risk groups (p<0.05). IBIS’ c-index was significantly higher than BCRAT (63.42 (59.35–67.49) vs 58.63 (54.05–63.21), p=0.013). PRS scores had a global calibration around 0.82, with a CI including one, and non-significant goodness-of-fit tests. PRS’ c-indexes were non-significantly higher than BCRAT and IBIS, the highest being 64.43 (58.23–70.63). Combined models did not improve the results.ConclusionsIn this French-Canadian population-based cohort, BCRAT and IBIS have good mean calibration that could be improved for risk subgroups, and modest discriminatory accuracy. Despite this modest discriminatory power, these tools can be of interest for primary care physicians for delivering a personalised message to their high-risk patients, regarding screening and lifestyle counselling.

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Breast Cancer Chemoprevention: A Practical Guide for the Primary Care Provider

Cited by 12 publications

References 65 publications

Perceptions of Racially and Ethnically Diverse Women at High Risk of Breast Cancer Regarding the Use of a Web-Based Decision Aid for Chemoprevention: Qualitative Study Nested Within a Randomized Controlled Trial

Perceptions of Racially and Ethnically Diverse Women at High Risk of Breast Cancer Regarding the Use of a Web-Based Decision Aid for Chemoprevention: Qualitative Study Nested Within a Randomized Controlled Trial

How to better identify and manage women with elevated breast cancer risk

Validation of breast cancer risk assessment tools on a French-Canadian population-based cohort

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