Noninitiation of Tamoxifen in Young Women at High Risk for Breast Cancer

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Conference Proceeding

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J AM Coll Surg


Introduction: Tamoxifen chemoprevention reduces the risk of breast cancer for high-risk patients, but initiation is low among young women. We sought to identify reasons for tamoxifen noninitiation among young high-risk patients. Methods: A retrospective study identified women younger than 46 years who received a high-risk diagnosis (BRCA mutation, lobular carcinoma in situ, atypical ductal hyperplasia/atypical lobular hyperplasia [ADH/ALH], flat epithelial atypia, strong family history), but did not initiate tamoxifen. Excluded were patients who opted for risk-reducing mastectomies, were younger than age 35, received a simultaneous cancer diagnosis, or had a history of tamoxifen use. Patient demographics were identified, along with information regarding discussions about tamoxifen initiation and reasons for noninitiation. Results: We included 67 patients with a median age of 41 years (range 35 to 45 years). The most common high-risk diagnosis was ADH (28.6%). Overall, perception of little benefit for tamoxifen therapy (46%) and lack of provider discussion (35%) were the most common reasons for noninitiation. No specific demographic factors were associated with a patient-provider discussion, but there was an association between ADH/ALH diagnosis and a discussion about tamoxifen (47.6% vs 36.0%, p = 0.02). Among those patients who did have a discussion about tamoxifen and did not initiate the medication, the most common reasons were a perception of little benefit (71%), followed by fertility concerns (22%). Conclusion: A perception of little benefit for treatment and a lack of provider discussion were the most common reasons for tamoxifen noninitiation. Improved strategies for education about the significant benefits of tamoxifen therapy are needed for both high-risk patients and providers.





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