Elevated risk thresholds predict endocrine risk-reducing medication use in the Athena screening registry

Area of Science:

• Oncology
• Preventive Medicine
• Pharmacology

Background:

• Risk-reducing endocrine therapy offers validated benefits for breast cancer prevention.
• Current utilization of these therapies is notably low despite FDA approval of tamoxifen and raloxifene.
• The Breast Cancer Risk Assessment Tool (BCRAT) identifies women with a 5-year risk ≥ 1.67% as candidates for therapy.

Purpose of the Study:

• To investigate the optimal risk threshold for identifying women likely to use endocrine risk-reducing therapies.
• To compare medication usage rates across different risk stratification methods in a real-world setting.

Main Methods:

• Analysis of data from the Athena Breast Health Network (2011-2018).
• Identification of high-risk women using a 5-year BCRAT risk ≥ 1.67% and age-based top 10% and 2.5% thresholds.
• Logistic regression was employed to estimate odds ratios for current medication use based on risk thresholds.

Main Results:

• Only 1.2% of 104,223 participants used risk-reducing medication.
• Women with a 5-year BCRAT risk ≥ 1.67% showed a higher likelihood of medication use (OR 3.94) compared to those below this threshold.
• The top 2.5% risk threshold demonstrated the strongest association with medication usage (OR 9.50) compared to the bottom 97.5%.

Conclusions:

• A 5-year BCRAT risk ≥ 1.67% is associated with modest use of risk-reducing endocrine therapy.
• The top 2.5% risk threshold is a more effective strategy for targeting medication use in high-risk women.
• Prospective randomized controlled trials are underway to further validate the top 2.5% threshold for optimizing therapy use.