Elevated risk thresholds predict endocrine risk-reducing medication use in the Athena screening registry.
Elevated risk thresholds predict endocrine risk-reducing medication use in the Athena screening registry.
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DOI：
10.1038/s41523-021-00306-9
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发表时间：
2021-08-03
影响因子：
5.9
通讯作者：
Esserman LJ
中科院分区：
文献类型：
--
作者：
Huilgol YS;Keane H;Shieh Y;Hiatt RA;Tice JA;Madlensky L;Sabacan L;Fiscalini AS;Ziv E;Acerbi I;Che M;Anton-Culver H;Borowsky AD;Hunt S;Naeim A;Parker BA;van 't Veer LJ;Athena Breast Health Network Investigators and Advocate Partners;Esserman LJ
降低风险的内分泌治疗的使用，虽然好处是有效的，但非常低。FDA已批准他莫昔芬和雷洛昔芬用于5年乳腺癌风险评估工具（BCRAT）风险≥1.67%。我们研究了2011-2018年雅典娜乳房健康网络参与者中高风险女性可能使用内分泌降低风险疗法的阈值。我们通过5年BCRAT风险≥1.67%以及按年龄划分风险阈值在前10%和2.5%的高危妇女来确定高危妇女。我们根据这些阈值使用逻辑回归估计当前药物使用的比值比（OR）。104,223名参与者中有1,201人（1.2%）使用药物。在5年BCRAT风险≥1.67%的33,082名参与者中，772名（2.3%）使用药物治疗。在前2.5%阈值的2445人中，209人（8.6%）使用药物。5年风险超过1.67%的参与者比风险低于该阈值的参与者更有可能使用药物，OR为3.94 （95% CI = 3.50-4.43）。排名前2.5%的人与药物使用的相关性最强，OR为9.50(8.13-11.09)，而排名后97.5%的人与用药的相关性最强。5年BCRAT≥1.67%的妇女有适度用药。我们证明，排名前2.5%的女性使用药物的几率高于排名后97.5%的女性，两者的风险为1.67%。最高2.5%的阈值将更有效地针对药物使用，目前正在一项随机对照临床试验中进行前瞻性测试。
Risk-reducing endocrine therapy use, though the benefit is validated, is extremely low. The FDA has approved tamoxifen and raloxifene for a 5-year Breast Cancer Risk Assessment Tool (BCRAT) risk ≥ 1.67%. We examined the threshold at which high-risk women are likely to be using endocrine risk-reducing therapies among Athena Breast Health Network participants from 2011–2018. We identified high-risk women by a 5-year BCRAT risk ≥ 1.67% and those in the top 10% and 2.5% risk thresholds by age. We estimated the odds ratio (OR) of current medication use based on these thresholds using logistic regression. One thousand two hundred and one (1.2%) of 104,223 total participants used medication. Of the 33,082 participants with 5-year BCRAT risk ≥ 1.67%, 772 (2.3%) used medication. Of 2445 in the top 2.5% threshold, 209 (8.6%) used medication. Participants whose 5-year risk exceeded 1.67% were more likely to use medication than those whose risk was below this threshold, OR 3.94 (95% CI = 3.50–4.43). The top 2.5% was most strongly associated with medication usage, OR 9.50 (8.13–11.09) compared to the bottom 97.5%. Women exceeding a 5-year BCRAT ≥ 1.67% had modest medication use. We demonstrate that women in the top 2.5% have higher odds of medication use than those in the bottom 97.5% and compared to a risk of 1.67%. The top 2.5% threshold would more effectively target medication use and is being tested prospectively in a randomized control clinical trial.
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统计评论14：逻辑回归。
影响因子：
15.1
作者：
Bewick, V;Cheek, L;Ball, J
通讯作者：
Ball, J
影响因子：
45.3
作者：
Freedman, Andrew N.;Yu, Binbing;McCaskill-Stevens, Worta
通讯作者：
McCaskill-Stevens, Worta
DOI：
10.6004/jnccn.2017.0003
发表时间：
2017-01-01
影响因子：
13.4
作者：
Daly, Mary B.;Pilarski, Robert;Darlow, Susan
通讯作者：
Darlow, Susan
影响因子：
4
作者：
Evans, D. Gareth;Harvie, Michelle;Howell, Anthony
通讯作者：
Howell, Anthony
影响因子：
3.5
作者：
Fagerlin, A;Zikmund-Fisher, BJ;Ubel, PA
通讯作者：
Ubel, PA