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    Chemoprevention Indication Score: a user-friendly tool for prevention of breast cancer - pilot analysis

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    Authors
    Layeequr Rahman, Rakhshanda
    Crawford, Sybil L.
    UMass Chan Affiliations
    Department of Medicine, Division of Preventive and Behavioral Medicine
    Department of Surgery
    Document Type
    Journal Article
    Publication Date
    2009-10-01
    Keywords
    Adult
    Antineoplastic Agents, Hormonal
    Breast Neoplasms
    Chemoprevention
    Female
    Humans
    Middle Aged
    *Patient Selection
    Pilot Projects
    Risk Assessment
    Tamoxifen
    Life Sciences
    Medicine and Health Sciences
    Women's Studies
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    Link to Full Text
    http://dx.doi.org/10.1016/j.breast.2009.08.001
    Abstract
    BACKGROUND: Despite the results of prospective randomized placebo controlled studies, endorsement from various professional societies, and approval by the FDA, the chemoprevention of breast cancer is limited. This is attributable to the perceived risks of complications with tamoxifen. Individualized risk-benefit calculation regarding the use of tamoxifen is burdensome for practical clinical use. We propose a Chemoprevention Indication Score (CIS) that is easy to compute and reliable to identify women suitable for chemoprevention. MATERIAL AND METHODS: Chart-review of all patients attending a university-based high-risk breast clinic identified the women offered chemoprevention and those who accepted it. Age, Gail risk score, past medical history and physician's reasons for not offering tamoxifen were recorded. CIS was developed weighing risks and benefits of tamoxifen; high, moderate and low indication score categories were defined for recommendation of tamoxifen. CIS was validated by cross-tabulating with the rate of physician recommendation of tamoxifen and by agreement with Gail's risk-benefit index. RESULTS: Between 2004 and 2006,105 women attended the high-risk clinic. Median (interquartile) age was 47 (42-53) yrs; 142(90%) were Caucasian. Median (interquartile) Gail score was 2.3 (1.0-3.2). Forty-eight (46%) women were offered tamoxifen while 15(14%) complied. Tamoxifen was offered to 1 of 5(20%) women with low; 32 of 82(39%) women with moderate and 15 of 18(83%) women with high CIS [p=0.0008]. The McNemar's test for agreement between CIS (or=6) and Gail's risk-benefit index was significant at pCONCLUSION: Inability to identify appropriate candidates has been a great barrier towards acceptance of chemoprevention for breast cancer. The CIS can be used for individual risk-benefit analysis for recommendation of breast cancer chemoprevention. However, CIS needs to be validated on a larger scale with methodologically more rigorous studies before proposing generalized use in the community.
    Source
    Breast. 2009 Oct;18(5):289-93. Epub 2009 Aug 29. Link to article on publisher's site
    DOI
    10.1016/j.breast.2009.08.001
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/50931
    PubMed ID
    19716702
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.breast.2009.08.001
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