在符合医疗保险条件的队列中，根据乳腺癌风险水平使用雷洛昔芬和他莫昔芬。
Use of raloxifene and tamoxifen by breast cancer risk level in a Medicare-eligible cohort.
机构信息
Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD.
Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD.
出版信息
Am J Obstet Gynecol. 2018 Jun;218(6):606.e1-606.e9. doi: 10.1016/j.ajog.2018.03.031. Epub 2018 Apr 7.
BACKGROUND
Raloxifene and tamoxifen are Food and Drug Administration-approved for breast cancer risk reduction; in 2013, the US Preventive Services Task Force recommended these drugs for breast cancer risk reduction in high-risk women. Information on the use of raloxifene and tamoxifen for breast cancer risk reduction in the general population indicates that the risk is believed to be low; however, there is little literature.
OBJECTIVE
The purpose of this study was to assess the use of breast cancer risk reduction medications by breast cancer risk level in an older cohort of women.
STUDY DESIGN
Women who were enrolled in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial were assessed for the use of raloxifene, tamoxifen, and other medications. The data sources for use of the drugs were a mailed medication use questionnaire in 2013 and linked Medicare Part D claims files from 2010-2014. Estimated breast cancer risk within 5 years was assessed with the use of the modified Gail model and self-reported breast cancer risk factors; comorbidities were assessed through a questionnaire.
RESULTS
A total of 22,235 women completed the medication use questionnaire; of these, 13,640 women (61%) had linked Part D data. In 2013, 45% of the women were 65-74 years old, and 55% of the women were 75-84 years old. From the medication use questionnaire, raloxifene use (past month) was 1.8%, 2.5%, and 4.0% for women with breast cancer risk within 5 years of <1.66%, 1.66-3.0%, and ≥3%, respectively (probability value trend, <.0001). From Part D, for any use during the period among women with coverage, raloxifene rates were 3.3%, 4.0%, and 6.6% for the 3 categories for breast cancer risk within 5 years (probability value trend, <.0001); use was 7.4% and 3.3% in women with and without osteoporosis, respectively. Raloxifene use significantly decreased from 2010-2014, and specifically from 2012-2014, both for all women and for women with breast cancer risk within 5 years of ≥3%. Tamoxifen use from Part D was 0.36%, 0.45%, and 0.85% for the 3 categories for breast cancer risk within 5 years (probability value trend, .009).
CONCLUSION
Raloxifene use was low overall but increased modestly with breast cancer risk, and usage decreased from 2010-2014. Tamoxifen use was very low.
背景
雷洛昔芬和他莫昔芬已获得美国食品药品监督管理局批准，可用于降低乳腺癌风险；2013 年，美国预防服务工作组建议高危女性使用这些药物来降低乳腺癌风险。有关雷洛昔芬和他莫昔芬在普通人群中降低乳腺癌风险的数据表明，风险被认为较低；然而，相关文献很少。
目的
本研究旨在评估在年龄较大的女性队列中，根据乳腺癌风险水平使用乳腺癌风险降低药物的情况。
研究设计
参加前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验的女性接受了雷洛昔芬、他莫昔芬和其他药物的使用评估。药物使用数据的来源是 2013 年的邮寄药物使用问卷和 2010-2014 年的医疗保险部分 D 索赔文件。使用改良 Gail 模型和自我报告的乳腺癌风险因素评估 5 年内的估计乳腺癌风险；通过问卷评估合并症。
结果
共有 22235 名女性完成了药物使用问卷；其中，13640 名女性（61%）有部分 D 数据。2013 年，45%的女性年龄在 65-74 岁之间，55%的女性年龄在 75-84 岁之间。从药物使用问卷中，雷洛昔芬（过去一个月）的使用率分别为<1.66%、1.66-3.0%和≥3%的女性，5 年内乳腺癌风险分别为 1.8%、2.5%和 4.0%（概率值趋势，<.0001）。从部分 D 来看，在有保险的女性中，任何期间的使用，5 年内乳腺癌风险分别为<1.66%、1.66-3.0%和≥3%的女性，雷洛昔芬的使用率分别为 3.3%、4.0%和 6.6%（概率值趋势，<.0001）；骨质疏松症女性的使用率分别为 7.4%和 3.3%。雷洛昔芬的使用率从 2010-2014 年显著下降，特别是从 2012-2014 年，所有女性和 5 年内乳腺癌风险≥3%的女性均如此。从部分 D 来看，5 年内乳腺癌风险分别为<1.66%、1.66-3.0%和≥3%的女性，他莫昔芬的使用率分别为 0.36%、0.45%和 0.85%（概率值趋势，.009）。
结论
雷洛昔芬的总体使用率较低，但随着乳腺癌风险的增加而略有增加，并且使用率从 2010-2014 年下降。他莫昔芬的使用率非常低。
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