Fear of Side Effects and Lack of Awareness: Barriers to Greater Use of Risk-Reducing Medications for Breast Cancer

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A “big problem, maybe the major one,” with risk-reducing medications for breast cancer is low uptake among women at high risk of breast cancer,” Seema A. Khan, MD, told participants at the 2021 Annual Lynn Sage Breast Cancer Symposium.1 Dr. Khan is Professor of Surgery and the Bluhm Family Professor of Cancer Research at Northwestern University Feinberg School of Medicine. She is also Co-Leader of the Cancer Prevention Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, which sponsored the symposium.

Dr. Khan cited a meta-analysis of 26 studies, involving more than 21,000 women. It found uptake of therapeutic agents was just about 25% among women participating in trials, and “in nontrial settings, it was much lower, at 9%, with an overall pooled estimate of 16%. These findings suggest that almost 85% of women who are eligible for risk-reducing medication do not avail themselves of it.”2

Factors Influencing Uptake

Factors associated with low uptake of risk-reducing medication include a lack of awareness by physicians and patients as well as a fear of side effects.3

The major factor associated with higher uptake was having an abnormal biopsy. “We know that women who have just experienced a biopsy showing atypical changes are particularly open to the idea of risk-reducing medication, particularly if recommended strongly by their physician, in the setting of a calculated higher objective risk, and there are fewer side effects or trial concerns,” Dr. Khan noted. Risk-reducing medications may also lower the frequency of unnecessary benign biopsies or false-positive results, Dr. Khan pointed out.

‘Extra Persuasion’ for Younger Women

“Generally, older women are more likely to accept risk-reducing medication, but it is, in fact, more helpful to younger women in many ways, as they would reap a longer duration of benefit (almost 20 years),” Dr. Khan said. “They also have a much better risk/benefit ratio and deserve the extra persuasion it takes to get them to accept.”

Although lifestyle changes can be helpful to most people, including in terms of benefits to the bones, brain, and heart, “the best cancer risk reduction value may reach about 25%. Drug therapy, on the other hand, reaches up to a 60% reduction in risk and therefore a substantially greater benefit,” Dr. Khan said. “This is something that needs to be explained quantitatively.” 

DISCLOSURE: Dr. Khan reported no conflicts of interest.


1. Khan S: Is breast cancer chemoprevention dead? 2021 Annual Lynn Sage Breast Cancer Symposium. October 1, 2021.

2. Smith SG, Sestak I, Forster A, et al: Factors affecting uptake and adherence to breast cancer chemoprevention: A systematic review and meta-analysis. Ann Oncol 27:575-590, 2016.

3. DeCensi A, Thorat MA, Bonanni B, et al: Barriers to preventive therapy for breast and other major cancers and strategies to improve uptake. Ecancermedicalscience 9:595, 2015.

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