Drugs to Reduce Breast Cancer Risk Are Rarely Used Show Data from Geisinger Health System

Caroline Helwick

February 2013, Vol 4, No 2 - Breast Cancer


San Antonio, TX—The uptake of US Food and Drug Administration (FDA)-approved drugs for risk reduction of breast cancer is still poor, as was confirmed by a study using the electronic health records (EHRs) from Geisinger Health System in Danville, PA. The researchers described the process of identifying women who are at increased risk for breast cancer and the use of risk-reducing drugs at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium.

Women who are at increased risk for breast cancer are eligible to take selective estrogen receptor modulators (SERMs) to reduce their risk. The American Society of Clinical Oncology recommends that the 2 FDA-approved SERMs, tamoxifen (Nolvadex) and raloxifene (Evista), be considered for women aged >35 years who have a 5-year risk of 1.67% or greater, “but identifying those women can be both challenging and costly,” said Joseph B. Leader, BA, Research Data Manager at Geisinger Health System.

“We used an electronic database from the Geisinger Health System Department of Radiology, with 77,000 women ages 35 to 90 years, to calculate the 5-year and lifetime risks of developing invasive breast cancer,” he said. They employed the National Cancer Institute Breast Cancer Risk Assessment macro, which calculates risk based on age, number of biopsies, presence of atypical hyperplasia, age at menarche, age at first live birth, number of first-degree relatives with breast cancer, and race. Demographic information was obtained from their EHR system. 

A total of 5897 patients (mean age, 65.8 years) met the criteria for risk, including 1728 women with a 5-year risk of 2% to 2.5%, another 3188 with a risk of 2.5% to 3%, and 981 with a risk of ≥3%. The mean 5-year risk for the at-risk population was 3.05% (maximum, 18.2%).

Of all the patients, 4196 had a primary care physician (PCP), and 4113 had seen their PCP within the past year. Altogether, 5086 patients had seen any Geisinger physician within the past year.

Despite this access to a physician, only 239 at-risk patients had ever received a prescription for tamoxifen or raloxifene, and some received raloxifene for the prevention or treatment of osteoporosis and not for breast cancer risk reduction. “Only 40 women were currently taking tamoxifen or raloxifene,” Mr Leader reported.

“These data from an integrated health system with an EHR closely reflect published national statistics that show the uptake of FDA-approved drugs for breast cancer risk reduction has been poor, following the FDA approval of both tamoxifen and raloxifene for breast cancer risk reduction,” he said.

Strategies are being designed to increase the use of tamoxifen and raloxifene within the Geisinger health plan by using the risk score to identify the population and to attempt to intervene using a risk modification clinical program, Mr Leader noted.