Cornell Lauren F, Klassen Christine L, Ghosh Karthik, Ball Colleen, Advani Pooja, Pruthi Sandhya
Division of Hematology/Oncology, Breast Diagnostic Clinic, Mayo Clinic, Jacksonville, Florida.
Division of General Internal Medicine, Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota.
Cancer Prev Res (Phila). 2024 Dec 3;17(12):565-570. doi: 10.1158/1940-6207.CAPR-24-0324.
Women at increased risk for breast cancer may benefit from taking risk-reducing medication (RRM) with tamoxifen (tam). Historical uptake of tam in women who qualify has been low. Recent studies have shown low-dose tam to have similar efficacy to standard dosing, with lower risk for adverse events. In this study, we aimed to evaluate uptake, adherence, and tolerability of low-dose tam in women at increased risk for breast cancer and those with ductal carcinoma in situ (DCIS). In this two-site prospective study, women who qualified for breast cancer RRM were offered participation and received consultation with a breast specialist for discussion of RRM rationale, benefits, side effects, and risks. Patients received baseline and 1-year follow-up surveys. A total of 41 patients consented for participation, and 31 completed 1-year follow-up. After initial consultation, 90% (n = 37) reported good/complete understanding of breast cancer risk. Of patients included in 1-year follow-up, 5 had DCIS, 13 had high-risk intraepithelial lesion, and 13 qualified based on Breast Cancer Risk Assessment Tool/International Breast Intervention Study calculation. Furthermore, 74% (n = 23) of patients reported that they took low-dose tam after consultation, with 78.2% (n = 18) of those still taking medication at 1 year. Patients who continued medication had higher estimated breast cancer risk compared with those who discontinued (International Breast Intervention Study 10-year risk, 12.7% vs. 7.6%; P = 0.027). All patients with DCIS initiated low-dose tam, and only one patient with DCIS had discontinued at 1 year. Uptake of low-dose tam after informed discussion is high. Adherence and tolerability at 1-year follow-up improved compared with those with traditional dosing of tam. Prevention Relevance: tam has been used extensively for breast cancer prevention in high-risk women. Historical uptake has been low because of concern for side effects and poor tolerability. Herein, we demonstrate that in the clinical setting, effective patient education and offering of a low-dose option can improve uptake in this high-risk population. See related Spotlight, p. 545.
乳腺癌风险增加的女性可能会从服用他莫昔芬（tam）这种降低风险的药物（RRM）中获益。符合条件的女性对tam的既往接受率较低。最近的研究表明，低剂量tam与标准剂量具有相似的疗效，不良事件风险更低。在本研究中，我们旨在评估低剂量tam在乳腺癌风险增加的女性以及原位导管癌（DCIS）女性中的接受率、依从性和耐受性。在这项双中心前瞻性研究中，符合乳腺癌RRM条件的女性被邀请参与，并接受乳腺专科医生的咨询，以讨论RRM的原理、益处、副作用和风险。患者接受基线调查和1年随访调查。共有41名患者同意参与，31名完成了1年随访。初始咨询后，90%（n = 37）报告对乳腺癌风险有良好/完全的理解。在纳入1年随访的患者中，5例患有DCIS，13例患有高危上皮内病变，13例根据乳腺癌风险评估工具/国际乳腺干预研究计算符合条件。此外，74%（n = 23）的患者报告在咨询后服用了低剂量tam，其中78.2%（n = 18）在1年时仍在服药。继续服药的患者与停药的患者相比，估计的乳腺癌风险更高（国际乳腺干预研究10年风险，12.7%对7.6%；P = 0.027）。所有DCIS患者均开始服用低剂量tam，只有1例DCIS患者在1年时停药。经过知情讨论后，低剂量tam的接受率很高。与传统剂量tam相比，1年随访时的依从性和耐受性有所改善。预防意义：tam已被广泛用于高危女性的乳腺癌预防。由于担心副作用和耐受性差，既往接受率一直较低。在此，我们证明在临床环境中，有效的患者教育和提供低剂量选择可以提高这一高危人群的接受率。见相关聚焦文章，第545页。
