Elevated risk thresholds predict endocrine risk-reducing medication use in the Athena screening registry

• Published in: NPJ breast cancer Vol. 7; no. 1; p. 102
• Main Authors: Huilgol, Yash S., Keane, Holly, Shieh, Yiwey, Hiatt, Robert A., Tice, Jeffrey A., Madlensky, Lisa, Sabacan, Leah, Fiscalini, Allison Stover, Ziv, Elad, Acerbi, Irene, Che, Mandy, Anton-Culver, Hoda, Borowsky, Alexander D., Hunt, Sharon, Naeim, Arash, Parker, Barbara A., van ‘T Veer, Laura J., Esserman, Laura J.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 03-08-2021; Nature Publishing Group; Nature Portfolio
• Subjects: 692/308/174; 692/699/67/1347; 692/699/67/2195; 692/699/67/2322; 692/700; Age; Biomedical and Life Sciences; Biomedicine; Breast cancer; Cancer Research; Cell Biology; Estrogens; FDA approval; Health care networks; Human Genetics; Medical research; Oncology; Prevention; Primary care; Risk assessment; Womens health
• ISSN: 2374-4677; 2374-4677
• DOI: 10.1038/s41523-021-00306-9

Risk-reducing endocrine therapy use, though the benefit is validated, is extremely low. The FDA has approved tamoxifen and raloxifene for a 5-year Breast Cancer Risk Assessment Tool (BCRAT) risk ≥ 1.67%. 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. 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 estimated the odds ratio (OR) of current medication use based on these thresholds using logistic regression. One thousand two hundred and one (1.2%) of 104,223 total participants used medication. Of the 33,082 participants with 5-year BCRAT risk ≥ 1.67%, 772 (2.3%) used medication. Of 2445 in the top 2.5% threshold, 209 (8.6%) used medication. 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). The top 2.5% was most strongly associated with medication usage, OR 9.50 (8.13–11.09) compared to the bottom 97.5%. Women exceeding a 5-year BCRAT ≥ 1.67% had modest medication use. 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%. The top 2.5% threshold would more effectively target medication use and is being tested prospectively in a randomized control clinical trial.