A system-level approach to improve the uptake of antiestrogen preventive therapy among women with atypical hyperplasia and lobular cancer in situ

Background: The low uptake of antiestrogen preventive therapy among women at high risk of developing breast cancer remains a challenge. We implemented a performance improvement program to increase the uptake of preventive therapy among women with atypical hyperplasia (AH) and lobular cancer in situ (LCIS). Methods: A performance improvement program was implemented at the MD Anderson Cancer Center (Houston, TX), November 2015 to February 2017, for patients with a new ( Results: Baseline uptake of preventive therapy was 44%. The program registered 408 patients with a new ( n = 87) or existing diagnosis ( n = 321) of AH/LCIS; mean age was 57 and 71% were non-Hispanic white. Ninety-eight percent of patients received a recommendation for preventive therapy. The overall prescribing of preventive therapy to patients with a new or existing diagnosis was 82% (monthly range, 40%–100%; P trend = 0.76) and 48% (monthly range, 27%–57%; P trend P Conclusion: A system-level approach improved the uptake of preventive therapy. Identifying women at the time of diagnosis of AH/LCIS and offering a strong recommendation are key components for improving acceptance and adherence with preventive therapy. Cancer Prev Res; 1–7. ©2018 AACR.