Abstract P3-03-14: Comparing risk of breast cancer and cardiovascular disease and uptake of chemoprevention and statins among racially/ethnically diverse women with atypical hyperplasia or lobular carcinoma in situ
Authors: Nilan Luisa , Amenta Jacquelyn N. , McGuinness Julia E. , Kukafka Rita , Crew Katherine D. , Lawal Kehinde 
Published: March 2023

Background: Chemoprevention with selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) has been shown in randomized controlled trials to decrease breast cancer incidence by 50-65% among women at high risk for breast cancer. However, chemoprevention uptake remains low among high-risk women. Women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS) derive the greatest benefit from SERMs and AIs for breast cancer risk reduction. A potential barrier to chemoprevention uptake is competing comorbidities, including atherosclerotic cardiovascular disease (ASCVD). We calculated risk of breast cancer and ASCVD among women with AH or LCIS and assessed uptake of chemoprevention and statins among women who met high-risk criteria for both breast cancer and ASCVD. Methods: We conducted a retrospective cohort study among women, age 40-74 years, with AH or LCIS diagnosed in 2007-2015 at Columbia University Irving Medical Center (CUIMC) in New York City. Eligible women had sufficient data in the electronic health record (EHR) to calculate 5 and 10-year invasive breast cancer risk according to the Breast Cancer Surveillance Consortium (BCSC) risk calculator, including age, race/ethnicity, first-degree family history of breast cancer, breast biopsy results, and mammographic density. We calculated 10-year ASCVD risk using the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) ASCVD risk calculator using additional EHR data, including systolic blood pressure, total and HDL cholesterol, history of diabetes, treatment for hypertension, and current smoking status. High-risk criteria to determine eligibility for SERMs/AIs and statins was defined as a 5-year invasive breast cancer risk 1.67% and 10-year ASCVD risk 7.5%, respectively. We compared mean 10-year risk of breast cancer vs. ASCVD using a paired t-test and uptake of SERMs/AIs vs. statins among women at high risk for breast cancer and ASCVD, respectively, using McNemar’s test. Results: Among 298 evaluable women, mean age was 58.2 years (standard deviation [SD], 8.34), with 33% non-Hispanic White, 41% Hispanic, 9% non-Hispanic Black, 6% Asian, and 11% other/unknown race/ethnicity. About 98% of women met high-risk criteria for breast cancer and 30% were high risk for ASCVD. Mean 10-year risk of breast cancer was higher than mean 10-year risk of ASCVD (9.14% vs. 6.69%, p&lt; 0.001). Among women who met high-risk criteria for both breast cancer and ASCVD, uptake of statins was higher compared to SERMs/AIs (58% vs. 21%, p&lt; 0.001). Comparing non-Hispanic Whites vs. racial/ethnic minorities, mean 10-year breast cancer risk was higher (12.12% vs. 7.71%, p&lt; 0.001), but there were no statistically significant differences in ASCVD risk or uptake of chemoprevention or statins. Conclusions: Among women with AH or LCIS, mean absolute risk of breast cancer was higher compared to risk of ASCVD, however, uptake of statins was higher compared to chemoprevention with SERMs or AIs. To address under-utilization of chemoprevention among high-risk women, use of SERMs or AIs should be placed in the context of medications used for other chronic diseases, such as statins for ASCVD.

Citation Format: Luisa Nilan, Jacquelyn N. Amenta, Julia E. McGuinness, Rita Kukafka, Katherine D. Crew, Kehinde Lawal. Comparing risk of breast cancer and cardiovascular disease and uptake of chemoprevention and statins among racially/ethnically diverse women with atypical hyperplasia or lobular carcinoma in situ [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-03-14.