As a result, the Food and Drug Administration (FDA) approved the use of selective estrogen receptor modulators (SERMs) tamoxifen and raloxifene in women with a 5-year BCRAT risk of 1.67% or greater, based on the average 5-year breast cancer risk for a 50-year-old white female 7, 19, 20. The Breast Cancer Risk Assessment Tool (BCRAT) risk model was developed by the National Cancer Institute for use in the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-01 breast cancer prevention trial. Studies have also suggested that patient adherence and use of prevention therapy is correlated to the absolute risk and targeting high-risk groups who would be amenable to risk-reducing therapy 13, 16, 17.Ī primary care physician’s recommendation often plays a significant role in a patient’s decision-making risk models were developed to determine risk level and who should consider risk-reducing therapy 18. These reasons include the fear of side effects, resistance to taking a medicine that is used for cancer treatment, objection to taking a medicine at all, the consistent reminder that they are high risk, and failure to appreciate the benefit that they would receive (by both primary care physicians and the woman at risk) 13, 14, 15. However, uptake remains low, for numerous reasons. According to the US Preventative Services Task Force (USPSTF), preventive therapy is recommended for high-risk women, and even younger women 9, 10, 11, 12. Prevention trials have shown unequivocally that endocrine risk-reducing medications (such as selective estrogen receptor modulators and aromatase inhibitors) lower breast cancer risk 1, 2, 3, 4, 5, 6, 7, 8. The top 2.5% threshold would more effectively target medication use and is being tested prospectively in a randomized control clinical trial. We demonstrate that women in the top 2.5% have higher odds of medication use than those in the bottom 97.5% and compared to a risk of 1.67%. Women exceeding a 5-year BCRAT ≥ 1.67% had modest medication use. The top 2.5% was most strongly associated with medication usage, OR 9.50 (8.13–11.09) compared to the bottom 97.5%. Participants whose 5-year risk exceeded 1.67% were more likely to use medication than those whose risk was below this threshold, OR 3.94 (95% CI = 3.50–4.43). Of 2445 in the top 2.5% threshold, 209 (8.6%) used medication. Of the 33,082 participants with 5-year BCRAT risk ≥ 1.67%, 772 (2.3%) used medication. One thousand two hundred and one (1.2%) of 104,223 total participants used medication. We estimated the odds ratio (OR) of current medication use based on these thresholds using logistic regression. We identified high-risk women by a 5-year BCRAT risk ≥ 1.67% and those in the top 10% and 2.5% risk thresholds by age. We examined the threshold at which high-risk women are likely to be using endocrine risk-reducing therapies among Athena Breast Health Network participants from 2011–2018. The FDA has approved tamoxifen and raloxifene for a 5-year Breast Cancer Risk Assessment Tool (BCRAT) risk ≥ 1.67%. Risk-reducing endocrine therapy use, though the benefit is validated, is extremely low.
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