Lauren F Cornell, Christine L Klassen, Karthik Ghosh, Colleen Ball, Pooja Advani, Sandhya Pruthi
{"title":"在乳腺癌高危患者中使用低剂量他莫昔芬,提高了他们对降低风险药物的接受度和依从性。","authors":"Lauren F Cornell, Christine L Klassen, Karthik Ghosh, Colleen Ball, Pooja Advani, Sandhya Pruthi","doi":"10.1158/1940-6207.CAPR-24-0324","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p>","PeriodicalId":72514,"journal":{"name":"Cancer prevention research (Philadelphia, Pa.)","volume":" ","pages":"565-570"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Improved Uptake and Adherence to Risk-Reducing Medication with the Use of Low-Dose Tamoxifen in Patients at High Risk for Breast Cancer.\",\"authors\":\"Lauren F Cornell, Christine L Klassen, Karthik Ghosh, Colleen Ball, Pooja Advani, Sandhya Pruthi\",\"doi\":\"10.1158/1940-6207.CAPR-24-0324\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>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.</p>\",\"PeriodicalId\":72514,\"journal\":{\"name\":\"Cancer prevention research (Philadelphia, Pa.)\",\"volume\":\" \",\"pages\":\"565-570\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-12-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cancer prevention research (Philadelphia, Pa.)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1158/1940-6207.CAPR-24-0324\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer prevention research (Philadelphia, Pa.)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1158/1940-6207.CAPR-24-0324","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
乳腺癌(BC)风险增加的妇女可能会从服用他莫昔芬(tam)的降低风险药物(RRM)中获益。一直以来,符合条件的妇女服用他莫昔芬的比例较低。最近的研究表明,低剂量他莫昔芬的疗效与标准剂量相似,但不良反应风险较低。在此,我们旨在评估 BC 风险增加的女性和 DCIS 患者对低剂量他汀的接受度、依从性和耐受性。在这项由两个研究机构进行的前瞻性研究中,符合 BC RRM 条件的女性均可参加,并接受乳腺专家的咨询,讨论 RRM 的原理、益处、副作用和风险。患者将接受基线和一年的随访调查。41 名患者同意参与,31 名患者完成了为期 1 年的随访。初次咨询后,90% 的患者(37 人)表示对 BC 风险有良好/全面的了解。在接受 1 年随访的患者中,5 人患有 DCIS,13 人患有高危上皮内病变,13 人符合 BCRAT/IBIS 计算条件。74%(23 人)的患者表示在就诊后服用了小剂量他汀,其中 78.2%(18 人)的患者在 1 年后仍在服药。与停止服药的患者相比,继续服药的患者估计的 BC 风险更高(IBIS 10 年风险 12.7% vs 7.6%,p = 0.027)。所有 DCIS 患者都开始服用低剂量他汀,只有 1 名 DCIS 患者在 1 年后停药。经过知情讨论后,接受低剂量 TAM 的比例很高。与传统塔姆剂量相比,1 年随访时的依从性和耐受性都有所改善。
Improved Uptake and Adherence to Risk-Reducing Medication with the Use of Low-Dose Tamoxifen in Patients at High Risk for Breast Cancer.
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.