Noninitiation of Tamoxifen in Young Women at High Risk for Breast Cancer
Kandagatla P, Dokic D, Kochkodan J, Yanik M, Goranta S, and Jeruss JS. Noninitiation of Tamoxifen in Young Women at High Risk for Breast Cancer. J Am Coll Surg 2019; 229(4):S38-S39.
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.