Prevention Therapy for Breast Cancer: How Can We Do Better?

Excerpt

Despite significant advances in therapy for breast cancer, it remains the most frequently diagnosed cancer and leading cause of death among women worldwide,1 thus underscoring the need for prevention. For many women, the presence of known risk factors, coupled with the availability of proven risk-reducing agents, provides significant opportunity for prevention. The study in this issue by Flanagan and colleagues investigates the uptake of prevention therapy for women with different risk factors, including benign breast disease, family history of breast and/or ovarian cancer, mutation in a known breast cancer-associated gene, or a history of radiation therapy to the chest prior to age 30 years.2 This was a retrospective review of a prospectively accrued cohort of 1506 high-risk women at Memorial Sloan Kettering Cancer Center. The cohort was weighted toward benign breast disease, with 96% of subjects having a biopsy showing either atypia, atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), or lobular carcinoma in situ (LCIS). Investigators examined several sources for clarification of prevention therapy use and/or reasons for no use and found that 24% of women had used or were using prevention therapy. They were able to identify reasons for lack of use in only 50% of non-users, finding fear of adverse effects to be the most common reason for refusal. This study has several clinically significant findings. First, low uptake of prevention therapy, and, surprisingly, low uptake for women with some form of benign breast disease. Second, lack of documentation of a discussion of prevention therapy for half of the women not taking prevention therapy. Lastly, and maybe most importantly, the majority of women who started prevention therapy completed 5 years, despite fear of adverse effects being the most common patient-related barrier to use. …