Harvard Medical School, Boston, MA, USA.
Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA.
Breast Cancer Res Treat. 2022 Jun;193(2):417-427. doi: 10.1007/s10549-022-06577-5. Epub 2022 Apr 4.
High-risk lesions (HRLs) of the breast are an indication for chemoprevention, yet uptake is low, largely due to concerns about side effects. In 2019, low-dose (5 mg) tamoxifen was demonstrated to reduce breast cancer risk with improved tolerance. We describe chemoprevention uptake in an academic clinic before and after the introduction of low-dose tamoxifen.
Females age ≥ 35 with HRLs who established care from April 2017 through January 2020 and eligible for chemoprevention were included. Rates of chemoprevention initiation before and after the introduction of low-dose tamoxifen (pre-2019 vs. post-2019) were compared with chi-squared tests. Logistic regression identified demographic and clinical factors associated with chemoprevention initiation. Kaplan-Meier methods determined the rates of discontinuation.
Among 660 eligible females with HRLs, 22.7% initiated chemoprevention. Median time from first visit to chemoprevention initiation was 54 days (interquartile range (IQR): 0-209); 31.0% (46/150) started chemoprevention > 6 months after their initial visit. Chemoprevention uptake was not significantly different pre-2019 vs. post-2019 (21.2% vs. 26.3%, p = 0.16); however, post-2019, low-dose tamoxifen became the most popular option (41.5%, 34/82). On multivariable analyses, age and breast cancer family history were significantly associated with chemoprevention initiation. Discontinuation rates at 1 year were lowest for low-dose tamoxifen (6.7%) vs. tamoxifen 20 mg (15.0%), raloxifene (20.4%), or an aromatase inhibitor (20.0%).
In this modern cohort, 22.7% of females with HRLs initiated chemoprevention with 31.0% initiating chemoprevention > 6 months after their first visit. Low-dose tamoxifen is now the most popular choice for chemoprevention, with low discontinuation rates at 1 year.
高危病变（HRL）是乳腺癌化学预防的指征，但接受率较低，主要是因为对副作用的担忧。2019 年，低剂量（5mg）他莫昔芬被证明可以降低乳腺癌风险，同时耐受性更好。我们描述了在引入低剂量他莫昔芬前后在学术诊所中化学预防的接受情况。
纳入 2017 年 4 月至 2020 年 1 月期间建立医疗护理且符合化学预防条件的 HRL 女性，年龄≥35 岁。比较低剂量他莫昔芬引入前后（2019 年前 vs. 2019 年后）化学预防的起始率，采用卡方检验进行比较。Logistic 回归分析确定与化学预防起始相关的人口统计学和临床因素。Kaplan-Meier 方法确定停药率。
在 660 名符合条件的 HRL 女性中，22.7%开始进行化学预防。从首次就诊到开始化学预防的中位时间为 54 天（四分位距（IQR）：0-209）；31.0%（46/150）在初始就诊后>6 个月开始化学预防。2019 年前与 2019 年后的化学预防接受率无显著差异（21.2% vs. 26.3%，p=0.16）；然而，2019 年后，低剂量他莫昔芬成为最受欢迎的选择（41.5%，34/82）。多变量分析显示，年龄和乳腺癌家族史与化学预防的起始显著相关。1 年的停药率以低剂量他莫昔芬最低（6.7%），其次是他莫昔芬 20mg（15.0%）、雷洛昔芬（20.4%）或芳香化酶抑制剂（20.0%）。
在这个现代队列中，22.7%的 HRL 女性开始进行化学预防，31.0%的女性在首次就诊后>6 个月开始化学预防。低剂量他莫昔芬是目前化学预防最受欢迎的选择，1 年的停药率低。
