Abstract PR01: Knowledge, attitudes, and uptake of breast cancer chemoprevention in a multi-ethnic cohort of high-risk women
Authors: Trivedi Meghna S. , Reimers Laura , Infante Katherine , Hershman Dawn L. , Maurer Matthew , Kalinsky Kevin , Aguilar Stephanie , Sandoval Rossy , Alvarez Maria C. , Kukafka Rita , Crew Katherine D. 
Published: October 2015

Background: Chemoprevention with anti-estrogens, such as tamoxifen, raloxifene, and aromatase inhibitors, has been shown to reduce breast cancer incidence in high-risk women; however, uptake remains low (&lt;5%). We examined knowledge, attitudes, and uptake of breast cancer chemoprevention in a racially/ethnically diverse high-risk population seen at an urban breast center.

Methods: We enrolled high-risk women and those with newly diagnosed ductal carcinoma in situ (DCIS), who were seen for an initial consultation by medical oncology at Columbia University Medical Center. Women eligible for chemoprevention with anti-estrogens had a 5-year breast cancer risk ≥1.67% or lifetime risk ≥20% according to the Gail or Tyrer-Cuzick models, lobular carcinoma in situ (LCIS), DCIS, or BRCA mutation. Patients completed a baseline questionnaire collecting information on health literacy, numeracy, breast cancer knowledge, perceived breast cancer risk, reasons for taking preventive actions, and attitudes toward chemoprevention using validated measures. Demographic and clinical data, including chemoprevention uptake and type of anti-estrogen, were collected from medical chart review.

Results: From August 2012 to July 2014, 69 women were enrolled and 45 were evaluable. Among evaluable women, median age was 51.5 years (range, 31.8-76.4); 51% were pre-menopausal; race/ethnicity, white/Hispanic/black/Asian/other (%): 49/24/16/9/2; risk category, elevated breast cancer risk/LCIS/DCIS/BRCA mutation (%): 49/18/29/4. Mean health literacy score was 0.74 (score range 0-4, lower scores indicate higher literacy) and 31% met criteria for low numeracy. At baseline, only 49% demonstrated good breast cancer knowledge and 45% perceived themselves to be at higher risk for breast cancer than the general population. Excluding women with DCIS, median lifetime breast cancer risk according to the Gail or Tyrer-Cuzick models was 29.2% (range, 10.3-92) and 42% had accurate risk perceptions (perceived risk within 10% of estimated lifetime risk). The most common reasons for wanting to take preventive action to lower breast cancer risk included to live longer (98%), to improve health (91%), and to do it for family (87%). Twenty-nine (64%) women had previously heard of a prescription medicine to prevent breast cancer, but only 34% had ever thought about taking an anti-estrogen for prevention. The most common concerns about side effects with tamoxifen were blood clots (47%) and uterine cancer (40%); with raloxifene, blood clots (77%); and with aromatase inhibitors, osteoporosis (59%) and arthritis symptoms (36%). Thirty (68%) women felt like they had enough information following the initial visit with the medical oncologist to decide whether or not to take chemoprevention. Overall, 22 (49%) started an anti-estrogen: 54% tamoxifen, 14% raloxifene, and 32% an aromatase inhibitor. The chemoprevention uptake rate was 69% for DCIS and 41% for the other risk categories combined.

Conclusions: In a multi-ethnic cohort of high-risk women, less than half demonstrated sufficient breast cancer knowledge and had accurate breast cancer risk perceptions. After consultation with a medical oncologist, over two-thirds felt they had sufficient information for chemoprevention decision-making. Our chemoprevention uptake rate was relatively high compared to the published literature, which may reflect the highly select women referred to a breast center and the comfort level of medical oncologists in prescribing anti-estrogens.

Citation Format: Meghna S. Trivedi, Laura Reimers, Katherine Infante, Dawn L. Hershman, Matthew Maurer, Kevin Kalinsky, Stephanie Aguilar, Rossy Sandoval, Maria C. Alvarez, Rita Kukafka, Katherine D. Crew. Knowledge, attitudes, and uptake of breast cancer chemoprevention in a multi-ethnic cohort of high-risk women. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr PR01.