A targeted performance improvement program increased the rate at which physicians and other health care providers recommended the use of antiestrogen preventive therapy for women with atypical hyperplasia (AH) and lobular cancer in situ (LCIS), according to the results of a single-center study.1
Preventive therapy using the selective estrogen-receptor modulators (SERMs), tamoxifen and raloxifene, or an aromatase inhibitor is recommended for all women at high risk of developing breast cancer; these treatments are strongly recommended in women with AH and LCIS. Women with AH/LCIS can reduce their risk for breast cancer by as much as 75% with these medications, but fewer than 30% of them take advantage, primarily because of lack of provider recommendation or concern about side effects.
“One of the reasons why there is very low uptake reported in the literature is that these drugs that are used for prevention are also used to treat women with breast cancer,” explained study researcher Abenaa M. Brewster, MD, professor of clinical cancer prevention at the University of Texas MD Anderson Cancer Center in Houston. “In addition, generally primary care doctors are the ones primarily seeing women at increased risk and are not very familiar with these drugs. Because of this lack of familiarity there is reluctance to recommend treatment.”
For this study, Dr Brewster and colleagues implemented a performance improvement program designed to increase uptake of these preventive therapies in practices throughout the MD Anderson Cancer Prevention Center and in satellite clinics. From November 2015 to February 2017, patients with AH or LCIS were screened prior to their clinic appointment to determine eligibility. Providers were then alerted to their patients registered on the program.
“We performed some education, detailing how strongly these medications work in these patients to reduce the risk of developing breast cancer, and taught them methods for giving strong recommendations,” Dr Brewster told Cancer Therapy Advisor.
After the visit, providers and patients were asked to complete a survey rating the strength of the recommendation for preventive therapy on a scale from 1 to 5.