title: Uptake of exemestane chemoprevention in postmenopausal women at increased risk for breast cancer.
abstract: Despite their efficacy, uptake of selective estrogen receptor modulators for breast cancer chemoprevention remains low. Exemestane, an aromatase inhibitor, has recently been identified as a potential chemopreventive option with fewer serious side effects compared with selective estrogen receptor modulators in postmenopausal women. The purpose of this study was to assess the uptake of exemestane in a breast cancer prevention clinic. A retrospective chart review was conducted to capture chemoprevention uptake by postmenopausal women presenting to the Yale Breast Cancer Prevention Clinic between November 2011 and November 2012. Descriptive statistics of the study population have been presented. Statistical analyses were carried out using SAS 9.3 (SAS Institute Inc., Cary, North Carolina, USA) between December 2012 and February 2013. Of 90 postmenopausal women, 56 were eligible for chemoprevention. Their mean age was 56.8 years. Among the women, 39% had osteopenia or osteoporosis. Thirteen women chose to start chemoprevention medication (23%). Although 31% of the chemopreventive medication administered included exemestane, only four of 56 postmenopausal women opted for exemestane (7%). Chemoprevention uptake rates of postmenopausal women in the setting of a breast cancer prevention clinic are higher than that reported in the general population; however, they remain low overall despite the inclusion of exemestane as an option. A significant proportion of postmenopausal women have decreased bone density, which is a potential barrier to exemestane uptake. The results provide practical implications suggesting that exemestane may have limited impact on breast cancer chemoprevention uptake. Further investigations should focus on understanding the factors that influence, predict, and increase chemoprevention uptake.
authors: aDepartmentof Medical Oncology, Yale Cancer Center, Yale School of Medicine bDepartment of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA cDepartment of Medical Oncology, Marmara University Pendik Training and Research Hospital, Marmara University School of Medicine, Ust Kaynarca, Istanbul, Turkey.
authors: Bilge
authors: B
authors: Aktas
authors: Mia
authors: M
authors: Sorkin
authors: Lajos
authors: L
authors: Pusztai
authors: Erin W
authors: EW
authors: Hofstatter
mesh_terms: D000368:Aged; D000730:Androstadienes / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000473:pathology / Q000517:prevention & control*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000517:prevention & control*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D017698:Postmenopause; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*
chemical_list: D000730:Androstadienes; D020845:Selective Estrogen Receptor Modulators; C056516:exemestane
references: Lancet. 2002 Sep 14;360(9336):817-24
references: 12243915
references: J Natl Cancer Inst. 2004 Dec 1;96(23):1751-61
references: 15572757
references: J Natl Cancer Inst. 2007 Feb 21;99(4):283-90
references: 17312305
references: J Am Board Fam Med. 2009 May-Jun;22(3):272-9
references: 19429733
references: J Natl Cancer Inst. 2005 Nov 16;97(22):1652-62
references: 16288118
references: JAMA. 2006 Jun 21;295(23):2727-41
references: 16754727
references: Cancer Epidemiol. 2012 Jun;36(3):237-48
references: 22459198
references: Cancer. 2005 Jan 1;103(1):209-10
references: 15540238
references: N Engl J Med. 2011 Jun 23;364(25):2381-91
references: 21639806
references: Breast Cancer Res Treat. 2010 Feb;119(3):613-20
references: 19908143
references: Clin Cancer Res. 1997 Jul;3(7):1101-8
references: 9815789
references: Cancer Discov. 2012 Jan;2(1):25-40
references: 22585166
references: Lancet. 1998 May 16;351(9114):1451-67
references: 9605801
references: Cancer Prev Res (Phila). 2010 Jun;3(6):696-706
references: 20404000
references: J Clin Oncol. 2009 Jul 1;27(19):3235-58
references: 19470930
references: Lancet Oncol. 2012 Mar;13(3):275-84
references: 22318095
references: J Geriatr Phys Ther. 2009;32(2):67-72
references: 20039585
references: J Clin Oncol. 2008 Mar 20;26(9):1537-43
references: 18349406
references: J Clin Oncol. 2011 Jun 10;29(17 ):2342-9
references: 21555689
references: J Clin Oncol. 1997 Jul;15(7):2483-93
references: 9215816
references: Lancet. 2003 Jan 25;361(9354):296-300
references: 12559863
references: J Clin Oncol. 2007 Sep 1;25(25):3877-83
references: 17761973
references: Breast Cancer Res. 2007;9(4):R52
references: 17692126
references: J Natl Cancer Inst. 2011 Sep 21;103(18):1397-402
references: 21753181
references: Cancer Detect Prev. 2007;31(5):375-83
references: 18037249
references: Cancer Epidemiol Biomarkers Prev. 2010 Feb;19(2):443-6
references: 20142242
references: J Clin Oncol. 2013 Aug 10;31(23):2942-62
references: 23835710
references: J Clin Oncol. 2010 Jun 20;28(18):3090-5
references: 20458026
references: Expert Rev Anticancer Ther. 2008 Sep;8(9):1377-85
references: 18759690
references: Patient Prefer Adherence. 2013;7:245-58
references: 23569364
references: Stat Med. 2011 May 10;30(10):1090-104
references: 21337591
references: J Natl Cancer Inst. 1998 Sep 16;90(18):1371-88
references: 9747868
references: Ann Oncol. 2004 Feb;15(2):211-7
references: 14760111
references: Ann Surg Oncol. 2001 Aug;8(7):580-5
references: 11508619
references: CA Cancer J Clin. 2006 May-Jun;56(3):168-83
references: 16737949
references: Curr Breast Cancer Rep. 2012 Sep 1;4(3):207-215
references: 23956815
references: J Natl Compr Canc Netw. 2010 Oct;8(10):1112-46
references: 20971838
references: J Steroid Biochem Mol Biol. 2008 Jul;111(1-2):13-7
references: 18514508
references: Breast Cancer Res Treat. 2010 May;121(1):101-10
references: 20306293
references: J Clin Oncol. 2011 Jun 10;29(17):2327-33
references: 21537036
references: Ann Fam Med. 2005 May-Jun;3(3):242-7
references: 15928228
references: Bone. 2004 Mar;34(3):384-92
references: 15003786
references: Osteoporos Int. 2013 Oct;24(10):2725-8
references: 23632827
references: Ann Intern Med. 2013 Nov 19;159(10):698-708
references: 24061412
references: JAMA. 1999 Jun 16;281(23):2189-97
references: 10376571
references: Breast Cancer Res Treat. 2011 Jun;127(3):681-8
references: 21442198