Disparities in Risk Reduction Therapy Recommendations for Young Women With Lobular Carcinoma In-Situ.

Journal Article (Journal Article)

BACKGROUND: Endocrine therapy (ET) significantly reduces the risk of breast cancer development in high-risk patients diagnosed with lobular carcinoma in situ (LCIS). However, the variables impacting recommendation and use of ET in young adults (YAs) is not well-studied. We examined the role of provider recommendation and patient acceptance for ET for YAs with LCIS. MATERIALS AND METHODS: The National Cancer Database was queried for women aged < 40 years with primary LCIS between 2000 and 2012. Socioeconomic, demographic, and treatment variables were examined to determine their impact on ET provider recommendation and initial patient acceptance of risk-reducing therapy. RESULTS: Among 1650 YA patients with LCIS, only 749 (45.4%) were recommended ET. On multivariable analysis, women > 30 years of age were more likely recommended ET than women < 30 years (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.10-2.47), African Americans more than other ethnicities (OR, 1.48; 95% CI, 1.1-2.0), and YAs treated in New England were more likely than those in the rest of the country (OR, 3.26; 95% CI, 2.0-5.2). Among YA women recommended ET, only 20.2% had a documented refusal. Only geography appeared to independently impact the likelihood of refusal, with YAs in the Southeastern-Central United States being most likely to refuse ET (OR, 5.4; 95% CI, 1.2-24.0). CONCLUSION: ET is underutilized for risk-reduction in YAs with LCIS. This underuse appears dependent on disparities in provider recommendation practices rather than non-acceptance of therapy. This may reflect regional practice patterns, community standards of care, or provider bias regarding the significance of LCIS as a risk factor for development of invasive cancer.

Full Text

Duke Authors

Cited Authors

  • Bandera, BC; Voci, A; Nelson, DW; Stern, S; Barrak, D; Fischer, TD; DiNome, ML; Goldfarb, M

Published Date

  • August 2020

Published In

Volume / Issue

  • 20 / 4

Start / End Page

  • e397 - e402

PubMed ID

  • 32081572

Electronic International Standard Serial Number (EISSN)

  • 1938-0666

Digital Object Identifier (DOI)

  • 10.1016/j.clbc.2020.01.006


  • eng

Conference Location

  • United States