Breast ca: Canadian study reveals low BD screening rate in older AET recipients

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Takeaway

  • Antiestrogen therapy (AET), especially aromatase inhibitors (AIs), increases osteoporosis risk.
  • Only 36% of patients with breast cancer (BC) aged ≥65 years starting AET receive guideline-recommended baseline bone densitometry (BD) screening.

Why this matters

  • Clinicians need to follow guideline-recommended osteoporosis screening among AET recipients.

Study design

  • Retrospective, population-based cohort study of 16,480 patients with BC initiating AET (12 months before/after), based on claims data (1998-2012) from Quebec's universal health care.
  • Funding: Canadian Institutes of Health Research; Canadian Cancer Society Research Institute; Quebec Health Research Fund.

Key results

  • 36.1% of all AET recipients received BD screening.
  • Screening rate was higher among AI recipients (58.4%).
  • Odds of receiving BD screening were lower with:
    • Age 70-79 (OR, 0.79; 95% CI, 0.72-0.86) and ≥80 years (OR, 0.41; 95% CI, 0.37-0.47);
    • Lower socioeconomic status (OR, 0.62; 95% CI, 0.52-0.72);
    • Tamoxifen-only therapy (OR, 0.27; 95% CI, 0.24-0.31);
    • Lack of periodic health exam (OR, 0.78; 95% CI, 0.72-0.86);
    • AET prescribed by general practitioner (OR, 0.81; 95% CI, 0.69-0.94);
    • Lack of guideline-appropriate radiotherapy (OR, 0.69; 95% CI, 0.57-0.83) or chemotherapy (OR, 0.82; 95% CI, 0.71-0.94);
    • AET nonadherence (OR, 0.76; 95% CI, 0.68-0.84).

Limitations

  • Retrospective design.
  • Unknown whether lack of screening is due to absence of physician recommendation or suboptimal follow-through.