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Breast Cancer Chemoprevention in Primary Care- Assessing Readiness for Change

Haiyun Wang, Claire F Snyder, Sharon Larson, Victor Vogel, H Lester Kirchner, Haiyan Sun, Xiaowei Yan

Purpose: Despite breast cancer chemoprevention recommendations, chemoprevention use remains low. We assess primary care providers’ (PCP) awareness and use of breast cancer chemoprevention, and perceived barriers/ solutions.

Methods: We conducted an online survey to investigate PCPs’ awareness and use of breast cancer chemoprevention, and perceived barriers/solutions. 161/426 (38%) eligible PCPs completed the survey.

Results: Of providers, 42% reported using breast cancer risk assessment models, only 9% prescribed breast cancer chemoprevention drugs in the past year. Providers using risk models were more likely to have made a breast cancer diagnosis in the past year (77% vs. 56%; p=0.01). Providers prescribed chemoprevention were older (mean 49 years vs. 40; p=0.01), more likely to be in practice ≥ 10 years (71% vs. 43%; p=0.04) and full time (79% vs. 49%; P=0.04); they all had diagnosed breast cancer in the past year (100% vs. 61%; p=0.002). Top three reported barriers to chemoprevention guideline adherence were lack of knowledge about chemoprevention drugs, unaware of chemoprevention guidelines, and inability to identify high-risk women. After adjustment for other provider characteristics and barriers, the PCPs who are unaware of chemoprevention guidelines have 3.1 increased odds (CI: 1.4-6.7) for not using risk assessment models. If high-risk women can be identified, 85% of respondents prefer referring appropriate women to a high-risk breast clinic.

Conclusion: PCPs infrequently assess breast cancer risk and rarely prescribe chemoprevention drugs for risk reduction. PCP education on breast cancer prevention and establishing high-risk breast clinics may improve breast cancer chemoprevention uptake.