Endocrine therapy initiation among women diagnosed with ductal carcinoma in situ from 2001 to 2018.

IF 3 3区 医学 Q2 ONCOLOGY Breast Cancer Research and Treatment Pub Date : 2024-12-01 Epub Date: 2024-08-16 DOI:10.1007/s10549-024-07453-0
Erin J Aiello Bowles, Cody Ramin, Jacqueline B Vo, Heather Spencer Feigelson, Jennifer C Gander, Lene H S Veiga, Clara Bodelon, Rochelle E Curtis, Carolyn Brandt, Amy Berrington de Gonzalez, Gretchen L Gierach
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Abstract

Purpose: Trials demonstrating benefits of tamoxifen for women with ductal carcinoma in situ (DCIS) were published > 20 years ago; yet subsequent uptake of endocrine therapy was low. We estimated endocrine therapy initiation in women with DCIS between 2001 and 2018 in a community setting, reflecting more recent years of diagnosis than previous studies.

Methods: This retrospective cohort included adult females ≥ 20 years diagnosed with first primary DCIS between 2001 and 2018, followed through 2019, and enrolled in one of three U.S. integrated healthcare systems. We collected data on endocrine therapy dispensings (tamoxifen, aromatase inhibitors [AIs]) from electronic pharmacy records within 12 months after DCIS diagnosis. Using generalized linear models with a log link and Poisson distribution, we estimated endocrine therapy initiation rates over time and by patient, tumor (including estrogen receptor [ER] status), and treatment characteristics.

Results: Among 2020 women with DCIS, 587 (29%) initiated endocrine therapy within 12 months after diagnosis (36% among 1208 women with ER-positive DCIS). Among women who used endocrine therapy, 506 (86%) initiated tamoxifen and 81 (14%) initiated AIs. Age-adjusted endocrine therapy initiation declined from 34 to 21% between 2001 and 2017; between 2015 and 2018, AI use increased from 8 to 35%. Women less likely to initiate endocrine therapy were ER-negative or had borderline/unknown or no ER test results, ≥ 65 years at diagnosis, Black, and received no radiotherapy.

Conclusion: One-third of women diagnosed with DCIS initiated endocrine therapy, and use decreased over time. Understanding why women eligible for endocrine therapy do not initiate is important to maximizing disease-free survival following DCIS diagnosis.

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2001年至2018年被诊断为导管原位癌的妇女开始接受内分泌治疗的情况。
目的:20多年前发表的试验表明,他莫昔芬对患有乳腺导管原位癌(DCIS)的妇女有益;但随后内分泌治疗的接受率很低。我们估算了 2001 年至 2018 年期间在社区环境中患有 DCIS 的妇女开始接受内分泌治疗的情况,这反映了比以往研究更近的诊断年份:该回顾性队列包括 2001 年至 2018 年间确诊为首次原发性 DCIS 且年龄≥ 20 岁的成年女性,随访至 2019 年,并在美国三个综合医疗保健系统之一登记。我们从电子药房记录中收集了 DCIS 诊断后 12 个月内的内分泌治疗配药(他莫昔芬、芳香化酶抑制剂 [AIs])数据。我们使用具有对数链接和泊松分布的广义线性模型,估算了不同时期以及不同患者、肿瘤(包括雌激素受体[ER]状态)和治疗特征的内分泌治疗启动率:在2020名DCIS女性患者中,有587人(29%)在确诊后12个月内开始接受内分泌治疗(在1208名ER阳性DCIS女性患者中,这一比例为36%)。在使用内分泌治疗的女性中,506人(86%)开始使用他莫昔芬,81人(14%)开始使用人工合成药物。2001年至2017年间,年龄调整后的内分泌治疗启动率从34%降至21%;2015年至2018年间,人工智能的使用率从8%增至35%。不太可能启动内分泌治疗的女性为ER阴性或ER检测结果为边缘/未知或无ER检测结果、诊断时年龄≥65岁、黑人、未接受放疗:结论:三分之一确诊为DCIS的女性开始接受内分泌治疗,随着时间的推移,内分泌治疗的使用率有所下降。了解符合内分泌治疗条件的妇女为何不开始内分泌治疗,对于最大限度地提高DCIS确诊后的无病生存率非常重要。
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来源期刊
CiteScore
6.80
自引率
2.60%
发文量
342
审稿时长
1 months
期刊介绍: Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.
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