Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York.
CUNY School of Medicine, New York, New York.
Cancer Prev Res (Phila). 2023 Dec 1;16(12):661-667. doi: 10.1158/1940-6207.CAPR-23-0181.
Breast cancer chemoprevention with selective estrogen receptor modulators (SERM) or aromatase inhibitors (AI) remains underutilized among high-risk women. A potential barrier to chemoprevention is competing comorbidities such as atherosclerotic cardiovascular disease (ASCVD), due to concern for additional medication side effects. We conducted a retrospective cohort study among women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS), an important target population for chemoprevention. We compared risks for breast cancer and ASCVD, as well as use of SERMs/AIs versus statins among high-risk women (defined as a 5-year invasive breast cancer risk ≥1.67% and 10-year ASCVD risk ≥7.5%, respectively). We used clinical data extracted from the electronic health record to calculate breast cancer risk according to the Breast Cancer Surveillance Consortium model and ASCVD risk according to the 2013 American College of Cardiology/American Heart Association risk calculator. Among 298 evaluable women, mean age was 58.2 years (SD, 8.34), with 33% non-Hispanic White, 41% Hispanic, 9% non-Hispanic Black, 6% Asian, and 11% other/unknown race/ethnicity. About 98% of women met high-risk criteria for breast cancer, whereas 30% were high-risk for ASCVD. Mean 10-year risk of breast cancer was higher than mean 10-year risk of ASCVD (9.14% vs. 6.69%; P < 0.001). Among women who met high-risk criteria for both diseases, use of statins was higher compared with SERMs/AIs (58% vs. 21%; P < 0.001). Among women with AH or LCIS, statin use was higher compared with breast cancer chemoprevention among eligible women, despite having a higher mean risk of breast cancer than ASCVD.
Among women with high-risk breast lesions, mean absolute risk of breast cancer was higher compared with cardiovascular disease; however, statin use was significantly higher than chemoprevention. To address underutilization of breast cancer chemoprevention, these drugs should be placed in the context of medications used to prevent other chronic diseases.
在高危女性中，选择性雌激素受体调节剂（SERM）或芳香酶抑制剂（AI）的乳腺癌化学预防仍未得到充分利用。化学预防的一个潜在障碍是存在动脉粥样硬化性心血管疾病（ASCVD）等竞争性合并症，这是由于担心额外的药物副作用。我们对患有非典型性增生（AH）或小叶原位癌（LCIS）的女性进行了一项回顾性队列研究，这些女性是化学预防的重要目标人群。我们比较了高危女性中乳腺癌和 ASCVD 的风险，以及 SERM/AI 与他汀类药物的使用情况（定义为 5 年浸润性乳腺癌风险≥1.67%，10 年 ASCVD 风险≥7.5%）。我们使用从电子健康记录中提取的临床数据，根据乳腺癌监测联盟模型计算乳腺癌风险，根据 2013 年美国心脏病学会/美国心脏协会风险计算器计算 ASCVD 风险。在 298 名可评估的女性中，平均年龄为 58.2 岁（标准差 8.34），33%为非西班牙裔白人，41%为西班牙裔，9%为非西班牙裔黑人，6%为亚洲人，11%为其他/未知种族/族裔。约 98%的女性符合乳腺癌高危标准，而 30%的女性有 ASCVD 高危风险。平均 10 年乳腺癌风险高于平均 10 年 ASCVD 风险（9.14%比 6.69%；P<0.001）。在同时患有两种疾病高危标准的女性中，他汀类药物的使用率高于 SERM/AI（58%比 21%；P<0.001）。在患有 AH 或 LCIS 的女性中，尽管患有乳腺癌的平均风险高于 ASCVD，但与合格女性的乳腺癌化学预防相比，他汀类药物的使用率更高。
在患有高危乳腺病变的女性中，乳腺癌的平均绝对风险高于心血管疾病；然而，他汀类药物的使用率明显高于化学预防。为了解决乳腺癌化学预防利用率低的问题，应将这些药物置于用于预防其他慢性疾病的药物背景下。
