Interventions to Improve Breast Cancer Preventive Medication Treatment Uptake: A Systematic Review

Despite the proven efficacy of selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) in reducing the incidence of breast cancer (BC) among high-risk individuals and the strong endorsement of their use in clinical guidelines, the uptake rates of these preventive medications remain suboptimal in clinical practice.

A systematic literature search was conducted across Ovid MEDLINE, Web of Science, and PsychINFO in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines from inception until December 31, 2024 (updated search conducted in January 2025) for experimental and observational studies that evaluate interventions to improve the uptake of BC preventive medication treatments among high-risk individuals. Risk of bias was assessed using National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools appropriate to the study design.

Fifteen studies met the inclusion criteria. Educational and decision aid-based interventions consistently facilitated informed decision making and improved knowledge of the participants but slightly improved the uptake rates of BC preventive medications. When combined with personalized educational and risk-assessment approaches, such as polygenic risk scores (PRSs), interventions demonstrated better uptake. A substantial uptake and good adherence of BC preventive treatments was achieved with an intervention that holistically targeted the healthcare system with healthcare providers' counseling and their proactive prescribing behavior integrated into routine practice.

Effective interventions should be comprehensive, tailored, implemented at multiple levels of care and integrated into standard clinical practice, holding the greatest potential for translating knowledge into action toward the uptake of BC preventive therapies among high-risk individuals.