Paschalis Kathryn, Marin Chelsea, Miller Kendall, Regis Crystal, Bates Katie, Gooch Jessica, Ling Marilyn, Dombrowski Jan, Yirinec Brian, Huston Alissa, Weiss Anna
Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
Ann Surg Oncol. 2025 Apr;32(4):2526-2533. doi: 10.1245/s10434-024-16857-7. Epub 2025 Jan 15.
Preventative medication (PM) uptake is low among patients at an elevated risk of breast cancer, largely due to fears of intolerance. This study aimed to investigate whether a new, surgical advanced practice provider (APP)-run clinic was effectively prescribing PM. We hypothesized equivalent rates of PM uptake compared to consultation with medical oncologists (MD).
The APP-run clinic and accompanying database were initiated 01/2023, including patients with benign breast complaints and/or an elevated risk of invasive breast cancer. A historic single-institution surgical database and this prospective database were queried for patients with ductal carcinoma in situ between 04/2007-05/2023 and 01/2023-01/2024, respectively. Patients with invasive breast cancer within the prior 5 years were excluded. Chart review abstracted PM type/dose. Chi square analysis compared PM uptake rates and dose.
A total of 523 patients met study criteria; the MD sample and APP sample were relatively well balanced except fewer hormone receptor positive patients in the MD sample (266/309 [86.1%] versus 202/214 [94.4%] APP, p < 0.01). PM uptake was lower in the MD sample (96/309 [31.1%] compared to the APP sample (86/214 [40.2%], p = 0.03). There was significantly more tamoxifen prescribed among the APP sample (58.2% vs. 35.6% among MD, p = 0.02), and low-dose tamoxifen prescribing increased significantly (47.3% vs. 9.8% MD, p < 0.01).
Our surgical APP-run breast health clinic has demonstrated equivalent PM uptake as compared to patients seen previously by medical oncologists. This model should be considered broadly. Additionally, low-dose tamoxifen has become the prescription of choice; thus, long-term studies of tamoxifen 5 mg are warranted.
在乳腺癌风险较高的患者中，预防性药物（PM）的使用率较低，主要是因为担心不耐受。本研究旨在调查由外科高级实践提供者（APP）运营的新诊所是否能有效开具预防性药物。我们假设与医学肿瘤学家（MD）会诊相比，预防性药物的使用率相当。
APP运营的诊所及相关数据库于2023年1月启动，纳入有良性乳腺疾病和/或浸润性乳腺癌风险较高的患者。分别查询了2007年4月至2023年5月及2023年1月至2024年1月期间导管原位癌患者的历史单机构外科数据库和该前瞻性数据库。排除过去5年内患有浸润性乳腺癌的患者。通过病历审查提取预防性药物的类型/剂量。采用卡方分析比较预防性药物的使用率和剂量。
共有523例患者符合研究标准；MD样本和APP样本相对平衡，只是MD样本中激素受体阳性患者较少（266/309 [86.1%] 对比APP样本中的202/214 [94.4%]，p < 0.01）。MD样本中预防性药物的使用率较低（96/309 [31.1%]），而APP样本中为（86/214 [40.2%]，p = 0.03）。APP样本中他莫昔芬的处方量显著更多（MD样本中为35.6%，APP样本中为58.2%，p = 0.02），且低剂量他莫昔芬的处方量显著增加（MD样本中为9.8%，APP样本中为47.3%，p < 0.01）。
我们由外科APP运营的乳腺健康诊所已证明，其预防性药物的使用率与之前医学肿瘤学家诊治的患者相当。应广泛考虑这种模式。此外，低剂量他莫昔芬已成为首选处方；因此，有必要对5毫克他莫昔芬进行长期研究。
