Estimates of the Number of U.S. Women Who Could Benefit From Tamoxifen for Breast Cancer Chemoprevention

Freedman, Andrew; Graubard, Barry I.; Rao, Sowmya R.; McCaskill‐Stevens, Worta; Ballard‐Barbash, Rachel; Gail, Mitchell H.

doi:10.1093/jnci/95.7.526

Cited by 235 publications

(151 citation statements)

References 12 publications

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“…Nevertheless, 30% of highrisk women failed to undergo recent mammograms We found few studies to date that have documented the prevalence of increased Gail scores in the general population, with estimates ranging from 6% to 16%, perhaps reflecting variability in age and sample criteria across studies. [31][32][33] In a national sample, we found that 15.7% of women ages 41-70 years had 5-year Gail risk estimates of Ն 1.66%. This estimate is similar to the 15.5% reported by Freedman et al 33 and is higher than the 8% reported by Bastian et al, 32 which may reflect the older age distribution of our study sample.…”

Section: Discussionmentioning

confidence: 85%

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Breast carcinoma screening and risk perception among women at increased risk for breast carcinoma

Sabatino

Burns

Davis

et al. 2004

Cancer

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BACKGROUNDThe Gail model is validated to estimate breast carcinoma risk. The authors assessed the association of Gail risk scores with screening and cancer risk perception.METHODSUsing the 2000 National Health Interview Survey, the authors studied women ages 41–70 without a cancer history. Gail scores ≥ 1.66% defined increased risk. The authors used logistic regression to assess associations between breast carcinoma risk and previous and recent (≤ 1 year) mammography and clinical breast examination (CBE).RESULTSOf 6410 women, 15.7% had increased risk. High‐risk women more frequently reported previous mammograms (94% vs. 85%; P < 0.0001), previous CBE (93% vs. 88%; P < 0.0001), recent mammograms (70% vs. 54%; P < 0.0001), recent CBE (71% vs. 61%; P < 0.0001), and high cancer risk perception (20% vs. 9%; P < 0.0001). However, 30% of high‐risk women had not received a recent mammogram. After adjustment for sociodemographic factors, access to care factors, and cancer risk perception, high‐risk women remained more likely to have received recent mammography (adjusted odds ratio [OR], 1.45, 95% confidence interval [95% CI], 1.19–1.77), recent CBE (OR, 1.32; 95% CI, 1.08–1.61]), and previous mammography than average‐risk women. The authors observed an interaction between risk and age, with women ages 41–49 years more frequently reporting previous mammography (OR, 4.79; 95% CI, 1.55–4.81) than average‐risk, same‐age women. For women age ≥ 50 years, the odds of previous mammography were similar regardless of risk.CONCLUSIONSIn a nationally representative sample, 15.7% of women had increased breast carcinoma risk using the Gail model. High‐risk women perceived higher cancer risk and more often received screening. However, nearly one in three high‐risk women did not receive recent screening and most of these women did not perceive increased risk. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 85%

“…[31][32][33] In a national sample, we found that 15.7% of women ages 41-70 years had 5-year Gail risk estimates of Ն 1.66%. This estimate is similar to the 15.5% reported by Freedman et al 33 and is higher than the 8% reported by Bastian et al, 32 which may reflect the older age distribution of our study sample.…”

Section: Discussionmentioning

confidence: 85%

Breast carcinoma screening and risk perception among women at increased risk for breast carcinoma

Sabatino

Burns

Davis

et al. 2004

Cancer

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“…According to the National Health Interview Survey (NHIS) in 2000, at least 15% of U.S. women 35 to 79 years old are eligible, according to the FDA criteria, for tamoxifen chemoprevention (42). Furthermore, close to 5% of U.S. white women would have benefits that outweigh the risks (42).…”

Section: Discussionmentioning

confidence: 99%

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

Zhang

Manson

2011

Cancer Prevention Research

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Treatment with the selective estrogen receptor modulator (SERM) tamoxifen for 5 years has produced dramatic breast cancer-related benefits in (a) the adjuvant setting, with 30% to 50% reductions in recurrence, contralateral disease, and mortality and (b) the prevention setting of healthy high-risk women, where tamoxifen reduces the risk of invasive and noninvasive breast cancer by 50%. Despite these striking data, adherence to tamoxifen is low, and low adherence is associated with poor survival. Although toxicity is a major predictor of poor adherence after starting therapy, pretreatment (baseline) predictors of poor tamoxifen adherence have been minimally studied. The adherence-survival link underscores the critical need to identify early predictors of poor adherence, and recent work is beginning to address this need. A major baseline predictor of poor adherence to prevention is current smoking, which is interestingly absent from studies of adherence to adjuvant therapy. Other important prevention adherence factors include breast cancer risk, extremes of age, non-white ethnicity, low socioeconomic status, and alcohol use. The strongest adjuvant therapy predictors are age (especially very young), ethnicity, and socioeconomic status. Future studies involving prospective systematic evaluation of these and other potential predictors in endocrine chemoprevention (e.g., other SERMs and aromatase inhibitors) are critical, as is the development of effective/targeted interventions to improve adherence and thus treatment outcomes in at-risk women.

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“…It is estimated that approximately 11% of women will develop breast cancer in their lifetime. Moreover, in the United States, it is estimated that based on year 2000 census data more than 2 million women could benefit from prophylactic use of TAM (Freedman et al, 2003), highlighting the importance of understanding the potential neurocognitive side effects of this agent. TAM is known to have both agonist and antagonist effects in the periphery and in the brain (McKenna et al, 1992).…”

Section: Hormonal Therapymentioning

confidence: 99%

Neuropsychological dysfunction associated with cancer and cancer therapies: a conceptual review of an emerging target

2004

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Estimates of the Number of U.S. Women Who Could Benefit From Tamoxifen for Breast Cancer Chemoprevention

Abstract: A substantial percentage of U.S. women would be eligible for tamoxifen chemoprevention according to FDA criteria, but a much smaller percentage would have an estimated net benefit. Nevertheless, this latter percentage corresponds to more than two million women.

Cited by 235 publications

References 12 publications

Breast carcinoma screening and risk perception among women at increased risk for breast carcinoma

Breast carcinoma screening and risk perception among women at increased risk for breast carcinoma

Predicting Adherence to Tamoxifen for Breast Cancer Adjuvant Therapy and Prevention

Neuropsychological dysfunction associated with cancer and cancer therapies: a conceptual review of an emerging target

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