title: Acceptance and adherence to chemoprevention among women at increased risk of breast cancer.
abstract: BACKGROUND
  Chemoprevention is an option for women who are at increased risk of breast cancer (five year risk ≥1.7%). It is uncertain, however, how often women accept and complete five years of therapy and whether clinical or demographic factors predict completion.
  
  
  METHODS
  Medical records were abstracted for 219 women whose five year risk of breast cancer was ≥1.7% and who were offered chemoprevention while attending a high risk breast clinic at the Moffitt Cancer Center. We examined the likelihood of accepting chemoprevention and completing five years of therapy, and potential clinical and demographic predictors of these outcomes, using multivariable logistic regression and survival analysis models.
  
  
  RESULTS
  There were 118/219 women (54.4%) who accepted a recommendation for chemoprevention and began therapy. The likelihood of accepting chemoprevention was associated with lifetime breast cancer risk and was higher for women with specific high risk conditions (lobular carcinoma in situ and atypical ductal hyperplasia). Women with osteoporosis and those that consumed alcohol were also more likely to accept medication. There were 58/118 (49.2%) women who stopped medication at least temporarily after starting therapy. Based on survival curves, an estimated 60% of women who begin chemoprevention will complete five years of therapy.
  
  
  CONCLUSIONS
  A substantial percentage of women at increased risk of breast cancer will decline chemoprevention and among those that accept therapy, approximately 40% will not be able to complete five years of therapy because of side effects.
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, USA; U. of South Florida, Department of Family Medicine, USA. Electronic address: rroetzhe@health.usf.edu.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Roetzheim
authors.affiliation: U. of New Mexico Cancer Center, USA.
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, USA.
authors.forename: William
authors.initials: W
authors.lastname: Fulp
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Matos Gomez
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, USA.
authors.forename: Elissa
authors.initials: E
authors.lastname: Clayton
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Tollin
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, USA.
authors.forename: Nazanin
authors.initials: N
authors.lastname: Khakpour
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Laronga
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, USA.
authors.forename: Marie Catherine
authors.initials: MC
authors.lastname: Lee
authors.affiliation: H. Lee Moffitt Cancer Center & Research Institute, USA.
authors.forename: John V
authors.initials: JV
authors.lastname: Kiluk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016588:Anticarcinogenic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D012306:Risk; D018570:Risk Assessment; D016019:Survival Analysis; D016903:Drug Monitoring
chemical_list: D016588:Anticarcinogenic Agents
keywords: Breast cancer; Breast cancer prevention; Chemoprevention; Lobular carcinoma in situ; Raloxifene; Tamoxifen