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Breast cancer prevention in older women: an algorithm to choose an optimal preventive agent

BACKGROUND: Breast cancer is a significant cause of morbidity and mortality in older women. The current study presents new, comprehensive guidelines for providing chemoprevention to older women. OBJECTIVE: The objective of this study was to develop and pilot test a chemopreventive choice algorithm t...

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Autores principales: Ozdemir, Burcu Z, Goodin, Joel B, Bodenner, Donald L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385772/
https://www.ncbi.nlm.nih.gov/pubmed/30858724
http://dx.doi.org/10.2147/BCTT.S179486
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author Ozdemir, Burcu Z
Goodin, Joel B
Bodenner, Donald L
author_facet Ozdemir, Burcu Z
Goodin, Joel B
Bodenner, Donald L
author_sort Ozdemir, Burcu Z
collection PubMed
description BACKGROUND: Breast cancer is a significant cause of morbidity and mortality in older women. The current study presents new, comprehensive guidelines for providing chemoprevention to older women. OBJECTIVE: The objective of this study was to develop and pilot test a chemopreventive choice algorithm to assess its feasibility for older women at high risk of breast cancer. DESIGN: The study observed outcomes of 23 older adult females being treated with one of the four different chemopreventive agents. A novel algorithm protocol was utilized for individualized chemopreventive selection. SETTING: The study was conducted in a high-risk outpatient clinic for older women. PARTICIPANTS: Older outpatient females at high risk (N=23) were offered chemopreventive options based on individual criteria. INTERVENTION: Literature review for breast cancer chemopreventive agents informed our development of a logic-based algorithm to guide treatment protocol and chemopreventive choice optimization. Selective estrogen receptive modulators (SERMs) were avoided in women with endometrial cancer risk (ie, pre-hysterectomy individuals), but used in women with low thromboembolic event (TE) risk. Raloxifene was used with osteoporotic women. Aromatase inhibitors (AIs) were used in women with high TE risk. Women without TE risks are advised to take SERMs. When bone density decreased due to AI use, women were switched to raloxifene. MEASUREMENTS/RESULTS: Of 23 participants of age ranging from 59 to 80 years (mean=72.6), two women developed estrogen receptor-positive breast cancer. Two participants, one who declined chemoprevention and one treated with an AI, developed breast cancer. All initial chemopreventive agents were selected according to the algorithm. Although minor adverse events occurred, each was managed by discontinuation or replacement of the chemopreventive agent. Discontinuation was most commonly due to side effect concerns or cost rather than experienced side effects. CONCLUSION: Outcomes of the initial utilization of the chemopreventive agent choice algorithm support the viability of the protocol, but further evaluation with a larger and more diverse sample is required.
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spelling pubmed-63857722019-03-11 Breast cancer prevention in older women: an algorithm to choose an optimal preventive agent Ozdemir, Burcu Z Goodin, Joel B Bodenner, Donald L Breast Cancer (Dove Med Press) Original Research BACKGROUND: Breast cancer is a significant cause of morbidity and mortality in older women. The current study presents new, comprehensive guidelines for providing chemoprevention to older women. OBJECTIVE: The objective of this study was to develop and pilot test a chemopreventive choice algorithm to assess its feasibility for older women at high risk of breast cancer. DESIGN: The study observed outcomes of 23 older adult females being treated with one of the four different chemopreventive agents. A novel algorithm protocol was utilized for individualized chemopreventive selection. SETTING: The study was conducted in a high-risk outpatient clinic for older women. PARTICIPANTS: Older outpatient females at high risk (N=23) were offered chemopreventive options based on individual criteria. INTERVENTION: Literature review for breast cancer chemopreventive agents informed our development of a logic-based algorithm to guide treatment protocol and chemopreventive choice optimization. Selective estrogen receptive modulators (SERMs) were avoided in women with endometrial cancer risk (ie, pre-hysterectomy individuals), but used in women with low thromboembolic event (TE) risk. Raloxifene was used with osteoporotic women. Aromatase inhibitors (AIs) were used in women with high TE risk. Women without TE risks are advised to take SERMs. When bone density decreased due to AI use, women were switched to raloxifene. MEASUREMENTS/RESULTS: Of 23 participants of age ranging from 59 to 80 years (mean=72.6), two women developed estrogen receptor-positive breast cancer. Two participants, one who declined chemoprevention and one treated with an AI, developed breast cancer. All initial chemopreventive agents were selected according to the algorithm. Although minor adverse events occurred, each was managed by discontinuation or replacement of the chemopreventive agent. Discontinuation was most commonly due to side effect concerns or cost rather than experienced side effects. CONCLUSION: Outcomes of the initial utilization of the chemopreventive agent choice algorithm support the viability of the protocol, but further evaluation with a larger and more diverse sample is required. Dove Medical Press 2019-02-19 /pmc/articles/PMC6385772/ /pubmed/30858724 http://dx.doi.org/10.2147/BCTT.S179486 Text en © 2019 Ozdemir et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Ozdemir, Burcu Z
Goodin, Joel B
Bodenner, Donald L
Breast cancer prevention in older women: an algorithm to choose an optimal preventive agent
title Breast cancer prevention in older women: an algorithm to choose an optimal preventive agent
title_full Breast cancer prevention in older women: an algorithm to choose an optimal preventive agent
title_fullStr Breast cancer prevention in older women: an algorithm to choose an optimal preventive agent
title_full_unstemmed Breast cancer prevention in older women: an algorithm to choose an optimal preventive agent
title_short Breast cancer prevention in older women: an algorithm to choose an optimal preventive agent
title_sort breast cancer prevention in older women: an algorithm to choose an optimal preventive agent
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6385772/
https://www.ncbi.nlm.nih.gov/pubmed/30858724
http://dx.doi.org/10.2147/BCTT.S179486
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