Comparing Breast Cancer and Cardiovascular Risk among Women Undergoing Screening Mammography: Why Are Statins More Widely Accepted Compared with Chemoprevention?

Although chemoprevention medications, including selective estrogen receptor modulators and aromatase inhibitors, are recommended for women at high risk for breast cancer, their uptake remains low. In contrast, statin use for atherosclerotic cardiovascular disease (ASCVD) risk reduction is widely adopted. We conducted a retrospective cohort study among a population of women aged 40 to 79 who underwent screening mammograms at Columbia University Irving Medical Center (CUIMC) from 2014 to 2016. For each woman, we calculated breast cancer risk using the Breast Cancer Surveillance Consortium version 3 (BCSCv3) risk calculator and ASCVD risk using the American Heart Association (AHA) risk calculator. High risk using the BCSCv3 calculator was defined as ≥5% invasive breast cancer risk at 10 years, and high risk using the AHA calculator was defined as >7.5% ASCVD risk at 10 years. Average 10-year risk of invasive breast cancer was lower than that for ASCVD (2.47% vs. 7.53%, P < 0.001). Based on disease risk, 4.7% and 34.4% of participants met high risk criteria for breast cancer and ASCVD, respectively. Chemoprevention uptake among women at high risk for breast cancer was lower than statin uptake among women at high risk for ASCVD (4.6% vs. 72.9%). Numerous barriers likely contribute to this discrepancy in uptake, including provider familiarity with and knowledge of chemoprevention, patient concerns about medication safety, absence of routine breast cancer risk assessment, and lack of intermediate biomarkers to monitor treatment response. Given the increased acceptance and uptake of statins relative to chemoprevention, there is potential value in putting chemoprevention in the context of statins to promote awareness and uptake. PREVENTION RELEVANCE: Among women undergoing screening mammograms, for women at high risk for breast cancer and ASCVD, chemoprevention uptake was lower than that of statins. We propose multiple barriers to account for this difference and describe how acceptance of statins could serve as a model for promoting the uptake of chemoprevention medications.