Can risk-reducing medications improve breast cancer prevention in childhood and adolescent cancer survivors? Comparative modeling to inform care

降低风险的药物可以改善儿童和青少年癌症幸存者的乳腺癌预防吗？

• 批准号: 10675772
• 负责人: Jennifer M. Yeh
• 金额: $ 64.4万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675772
• 关键词: Address; Adolescent; Affordable Care Act; Age; Anthracycline; Area; Aromatase Inhibitors; BRCA1 Mutation; Black race; Breast; Breast Cancer Detection; Breast Cancer Early Detection; Breast Cancer Prevention; Breast Cancer Risk Factor; Cancer Intervention and Surveillance Modeling Network; Cancer Survivor; Caring; Cessation of life; Chest; Childhood; Childhood Cancer Survivor Study; Clinical; Clinical Course of Disease; Cohort Studies; Collaborations; Combination Medication; Communities; Data; Decision Aid; Decision Modeling; Development; Disparity; Dose; Early Diagnosis; Economics; Elements; Estrogen receptor positive; Exposure to; Face; Female; Goals; Guidelines; High Risk Woman; Incidence; Internal Medicine; Intervention; Knowledge; Late Effects; Magnetic Resonance Imaging; Malignant Neoplasms; Mammography; Medicine; Methodology; Modality; Modeling; Morbidity - disease rate; Outcome; Pediatric Oncology Group; Performance; Pharmaceutical Preparations; Postmenopause; Prevention; Prevention trial; Preventive; Primary Cancer Prevention; Primary Prevention; Publishing; Quality of life; Race; Radiation; Recommendation; Regimen; Research; Resources; Risk; Risk Reduction; Saint Jude Children' s Research Hospital; Selective Estrogen Receptor Modulators; Shapes; Societies; Survivors; Tamoxifen; United States National Academy of Sciences; United States Preventative Services Task Force; Woman; Work; barrier to care; care providers; chemotherapy; childhood cancer survivor; clinical care; clinically relevant; comparative; cost; follow-up; high risk; improved; innovation; malignant breast neoplasm; models and simulation; mortality; mortality disparity; mortality risk; mutation carrier; network models; prospective; routine screening; screening; screening guidelines; shared decision making; side effect; standard care; survivorship; tumor; uptake; web site

PROJECT SUMMARY/ABSTRACT Survivors of childhood and adolescent cancer (“survivors”) face high risks for early mortality and treatment- related late effects, including subsequent breast cancer. Approximately 30% of female survivors previously treated with chest radiation will develop breast cancer before age 50, a risk similar to BRCA1 mutation carriers. The Children’s Oncology Group recommends early screening for breast cancer (in those who received radiation) starting at age 25, but <15% of survivors are adherent, many because of economic barriers. Risk- reducing medications, such as selective estrogen receptor modulators and aromatase inhibitors, could allow some survivors to avoid breast cancer entirely (vs. early detection with screening and treatment) since these drugs reduce the risk of estrogen receptor positive (ER+) tumors by 50% and are recommended for high-risk women by the U.S. Preventive Services Task Force. However, risk-reducing medications are not currently standard care for high-risk survivors which includes not only those previously treated with radiation but given emerging data, those who were exposed to high doses of anthracycline chemotherapy. The rarity of childhood and adolescent cancer and the long latency needed to capture subsequent cancers limit the feasibility of prospective prevention trials. Addressing all RFA-CA-20-027 priority areas, we propose to use simulation modeling and longitudinal observational data to inform clinical care by evaluating the clinical benefits and harms of risk-reducing medications among childhood and adolescent cancer survivors. We will build on our established collaboration with the Cancer Intervention and Surveillance Modeling Network (CISNET), the Childhood Cancer Survivor Study (CCSS) and the St. Jude Lifetime Cohort Study to: (1) refine two CISNET models to reflect current knowledge on breast cancer risk, screening and prevention among survivors; (2) provide model results in readily accessible online look-up tables summarizing benefits (e.g., avoiding breast cancer), harms (e.g., medication side effects) and costs to women and society of adding risk-reducing medication use for 5 years to screening; and (3) conduct exploratory analyses to assess the impact of risk- reducing medications and screening on outcomes by race. Our proposed research will have high potential to reshape current paradigms for survivorship care, using breast cancer risk-reducing medications as an example for understanding how preventive agents can be incorporated into current survivorship recommendations and practice. This work will also provide a framework to illuminate key elements and intervention points that can guide efforts to minimize disparities. This project is conceptually innovative and clinically important by simultaneously considering proven effective primary cancer prevention medicines together with screening recommendations. This work will be highly translational by providing data to inform clinical care guidelines and create resources that survivors and care-providers can use to guide care discussions on breast cancer prevention and early detection.

项目概要/摘要 儿童和青少年癌症幸存者（“幸存者”）面临早期死亡和治疗的高风险 - 相关的后期影响，包括随后的乳腺癌。此前大约有 30% 的女性幸存者 接受胸部放射治疗的人会在 50 岁之前罹患乳腺癌，其风险与 BRCA1 突变携带者类似。 儿童肿瘤学小组建议早期筛查乳腺癌（对于接受过乳腺癌治疗的患者） 辐射）从 25 岁开始，但<15％的幸存者坚持其中，许多是因为经济障碍。风险- 减少药物，例如选择性雌激素受体调节剂和芳香酶抑制剂，可以使 一些幸存者完全避免乳腺癌（相对于通过筛查和治疗进行早期发现），因为这些 药物可将雌激素受体阳性 (ER+) 肿瘤的风险降低 50%，推荐用于高风险人群 美国预防服务工作组的女性。然而，目前还没有降低风险的药物 对高危幸存者的标准护理，不仅包括那些以前接受过放射治疗但接受过放射治疗的幸存者 新出现的数据显示，那些接受高剂量蒽环类化疗的人。童年的难得 和青少年癌症以及捕获后续癌症所需的长潜伏期限制了 前瞻性预防试验。针对所有 RFA-CA-20-027 优先领域，我们建议使用模拟 建模和纵向观察数据通过评估临床效益和为临床护理提供信息 降低风险药物对儿童和青少年癌症幸存者的危害。我们将在我们的基础上再接再厉 与癌症干预和监测建模网络 (CISNET) 建立了合作关系 儿童癌症幸存者研究 (CCSS) 和圣裘德终身队列研究旨在：(1) 完善两个 CISNET 反映幸存者当前乳腺癌风险、筛查和预防知识的模型； (2) 在易于访问的在线查找表中提供模型结果，总结好处（例如，避免乳房 癌症）、危害（例如药物副作用）以及增加降低风险对妇女和社会的成本 筛选药物使用 5 年； (3) 进行探索性分析以评估风险的影响 减少药物治疗并按种族筛选结果。我们提出的研究将具有很大的潜力 以降低乳腺癌风险的药物为例，重塑当前的生存护理模式 了解如何将预防药物纳入当前的生存建议中，以及 实践。这项工作还将提供一个框架来阐明关键要素和干预点，这些要素和干预点可以 指导尽量减少差距的努力。该项目在概念上具有创新性且具有临床重要性 同时考虑经过证明有效的初级癌症预防药物和筛查 建议。这项工作将通过提供数据来指导临床护理指南和 创建幸存者和护理人员可用来指导乳腺癌护理讨论的资源 预防和早期发现。