Patients with DCIS Seen at a Specialized High-Risk Breast Clinic Run by Surgical Advanced Practice Providers Have High Rates of Preventive Medication Uptake

Kathryn Paschalis; Chelsea Marin; Kendall Miller; Crystal Regis; Katie Bates; Jessica Gooch; Marilyn Ling; Jan Dombrowski; Brian Yirinec; Alissa Huston; Anna Weiss

doi:10.1245/s10434-024-16857-7

Patients with DCIS Seen at a Specialized High-Risk Breast Clinic Run by Surgical Advanced Practice Providers Have High Rates of Preventive Medication Uptake

Ann Surg Oncol. 2025 Jan 15. doi: 10.1245/s10434-024-16857-7. Online ahead of print.

Authors

Kathryn Paschalis¹, Chelsea Marin¹, Kendall Miller², Crystal Regis³, Katie Bates³, Jessica Gooch^{2

3}, Marilyn Ling^{2

4}, Jan Dombrowski^{2

4}, Brian Yirinec^{2

5}, Alissa Huston^{2

5}, Anna Weiss^{6

7}

Affiliations

¹ Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
² Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA.
³ Division of Surgical Oncology, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
⁴ Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
⁵ Division of Medical Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
⁶ Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA. [email protected].
⁷ Division of Surgical Oncology, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA. [email protected].

PMID: 39815075
DOI: 10.1245/s10434-024-16857-7

Abstract

Background: Preventative medication (PM) uptake is low among patients at an elevated risk of breast cancer, largely due to fears of intolerance. This study aimed to investigate whether a new, surgical advanced practice provider (APP)-run clinic was effectively prescribing PM. We hypothesized equivalent rates of PM uptake compared to consultation with medical oncologists (MD).

Patients and methods: The APP-run clinic and accompanying database were initiated 01/2023, including patients with benign breast complaints and/or an elevated risk of invasive breast cancer. A historic single-institution surgical database and this prospective database were queried for patients with ductal carcinoma in situ between 04/2007-05/2023 and 01/2023-01/2024, respectively. Patients with invasive breast cancer within the prior 5 years were excluded. Chart review abstracted PM type/dose. Chi square analysis compared PM uptake rates and dose.

Results: A total of 523 patients met study criteria; the MD sample and APP sample were relatively well balanced except fewer hormone receptor positive patients in the MD sample (266/309 [86.1%] versus 202/214 [94.4%] APP, p < 0.01). PM uptake was lower in the MD sample (96/309 [31.1%] compared to the APP sample (86/214 [40.2%], p = 0.03). There was significantly more tamoxifen prescribed among the APP sample (58.2% vs. 35.6% among MD, p = 0.02), and low-dose tamoxifen prescribing increased significantly (47.3% vs. 9.8% MD, p < 0.01).

Conclusions: Our surgical APP-run breast health clinic has demonstrated equivalent PM uptake as compared to patients seen previously by medical oncologists. This model should be considered broadly. Additionally, low-dose tamoxifen has become the prescription of choice; thus, long-term studies of tamoxifen 5 mg are warranted.