Perceptions of Chemoprevention Among Women at High Risk for Breast Cancer.

Importance: Breast cancer (BC) chemoprevention (CP) is highly effective in reducing invasive BC risk, yet uptake among eligible women at high risk remains critically low. Prior research has not adequately examined CP decision-making alongside other primary prevention therapies, such as statins, in the practical context of multimorbidity and polypharmacy. Objective: To identify cognitive, emotional, and perceptual factors associated with accepting statins while declining or deferring breast cancer chemoprevention. Design, Setting, and Participants: In this exploratory qualitative study, in-depth semistructured interviews were conducted at a single academic health system between December 2024 and June 2025 with women aged 40 to 79 years at elevated risk for BC. Interviews focused on experiences with and perceptions of both BC chemoprevention and statin therapy. Analysis used an iterative, team-based thematic approach supported by a novel hybrid artificial intelligence-human coding workflow. Main Outcomes and Measures: The primary outcomes were themes identified through thematic analysis that explain systematic differences in patient acceptance of statins and deferral of CP agents. Results: Among 17 women with high risk for BC (mean [SD] age, 54.5 [10.6] years), 3 overarching categories of themes were identified: (1) risk framing, (2) trade-offs, and (3) pathway complexity. Statins were commonly framed as routine, low-burden, measurable interventions that fit easily into a familiar model of preventive care. In contrast, CP was often perceived as a high-burden, uncertainty-heavy, identity-relevant cancer treatment with benefits experienced as probabilistic, long-term, and invisible. This asymmetry was amplified by multimorbidity and polypharmacy, contributing to treatment fatigue and fragmented clinical pathways in which statins receive clear, prescriptive guidance; however, CP is offered through nondirective, complex discussions across multiple specialists. Conclusions and Relevance: In this qualitative study, the divergence in women's decisions about statins vs CP reflected a systematic interplay of drug-specific beliefs, emotional heuristics, and health system structures. These asymmetries may be addressed by reframing CP as a member of a family of preventive risk-reducing medications, presenting it as a reversible and time-limited trial, and embedding it in clearer, more integrated clinical communication with decision support, which may increase appropriate CP uptake among women at high risk.