Huilgol Yash S, Keane Holly, Shieh Yiwey, Hiatt Robert A, Tice Jeffrey A, Madlensky Lisa, Sabacan Leah, Fiscalini Allison Stover, Ziv Elad, Acerbi Irene, Che Mandy, Anton-Culver Hoda, Borowsky Alexander D, Hunt Sharon, Naeim Arash, Parker Barbara A, van 't Veer Laura J, Esserman Laura J
University of California, San Francisco, San Francisco, CA, USA.
University of California, Berkeley, Berkeley, CA, USA.
NPJ Breast Cancer. 2021 Aug 3;7(1):102. doi: 10.1038/s41523-021-00306-9.
Risk-reducing endocrine therapy use, though the benefit is validated, is extremely low. The FDA has approved tamoxifen and raloxifene for a 5-year Breast Cancer Risk Assessment Tool (BCRAT) risk ≥ 1.67%. We examined the threshold at which high-risk women are likely to be using endocrine risk-reducing therapies among Athena Breast Health Network participants from 2011-2018. We identified high-risk women by a 5-year BCRAT risk ≥ 1.67% and those in the top 10% and 2.5% risk thresholds by age. We estimated the odds ratio (OR) of current medication use based on these thresholds using logistic regression. One thousand two hundred and one (1.2%) of 104,223 total participants used medication. Of the 33,082 participants with 5-year BCRAT risk ≥ 1.67%, 772 (2.3%) used medication. Of 2445 in the top 2.5% threshold, 209 (8.6%) used medication. Participants whose 5-year risk exceeded 1.67% were more likely to use medication than those whose risk was below this threshold, OR 3.94 (95% CI = 3.50-4.43). The top 2.5% was most strongly associated with medication usage, OR 9.50 (8.13-11.09) compared to the bottom 97.5%. Women exceeding a 5-year BCRAT ≥ 1.67% had modest medication use. We demonstrate that women in the top 2.5% have higher odds of medication use than those in the bottom 97.5% and compared to a risk of 1.67%. The top 2.5% threshold would more effectively target medication use and is being tested prospectively in a randomized control clinical trial.
尽管降低风险的内分泌疗法的益处已得到验证，但其使用极为罕见。美国食品药品监督管理局（FDA）已批准他莫昔芬和雷洛昔芬用于乳腺癌风险评估工具（BCRAT）预测的5年风险≥1.67%的情况。我们在雅典娜乳腺健康网络2011 - 2018年的参与者中，研究了高危女性可能使用内分泌风险降低疗法的阈值。我们通过5年BCRAT风险≥1.67%以及按年龄划分处于风险阈值前10%和2.5%的情况来确定高危女性。我们使用逻辑回归基于这些阈值估计当前用药的优势比（OR）。在104,223名总参与者中，1201人（1.2%）使用了药物。在33,082名5年BCRAT风险≥1.67%的参与者中，772人（2.3%）使用了药物。在处于前2.5%阈值的2445人中，209人（8.6%）使用了药物。5年风险超过1.67%的参与者比风险低于此阈值的参与者更有可能使用药物，优势比为3.94（95%置信区间 = 3.50 - 4.43）。前2.5%与药物使用的关联最为强烈，与最低的97.5%相比，优势比为9.50（8.13 - 11.09）。5年BCRAT≥1.67%的女性用药情况适中。我们证明，处于前2.5%的女性比处于最低97.5%的女性以及与风险为1.67%的情况相比，有更高的用药几率。前2.5%的阈值能更有效地针对药物使用情况，并且正在一项随机对照临床试验中进行前瞻性测试。
