Table A3.
Variables Evaluated for Association With Chemoprevention Interest or Decision
| Variable | First Author | Description of Subjects | Association With Chemoprevention Interest or Decision |
|
|---|---|---|---|---|
| Unadjusted Results, P | Adjusted (multivariable) Results, OR (95% CI), P | |||
| Personal demographic variables | ||||
| Age | Bastian20 | General population of insured women | Subjects age 50-55 years, 24% interested; age 40-45 years, 21% interested; P = NS | Interest: age 50-55 years v 40-45 years, 1.0 (0.7 to 1.4); P = NS |
| Fashing22 | General population of women seeing gynecologist | Subjects age 65-85 years, 54% interested; 55-64 years, 54%; 45-54 years, 60%; 35-44 years, 57%; P = .008 | ||
| Fagerlin23 | 5-year Gail score risk ≥ 1.7 | Subjects < age 60 years more likely to be interested than ≥ 60 years; χ2 = 4.32, P < .04 | ||
| Melnikow28 | 5-year Gail score risk ≥ 1.7 | Subjects age < 65 years, 20% interested; 65-74 years, 17%; > 74 years, 17%; P = NS | ||
| Meiser27 | Women of unknown mutation status from family of dominantly inherited susceptibility to breast cancer | Subjects age < 30 years, 51% interested; 30-39 years, 56%; 40-49 years, 53%; ≥ 50, 33%; P = .069 | ||
| Tjia32 | Women age 60-65 years with primary care provider | Subjects reporting “No interest,” mean age 62 years; “unsure,” 62 years; “interested,” 62 years; P = NS | “No interest” v “unsure”: Age (per 1 -year increase); 1.04 (0.9 to 1.2); P = NS “Interested” v “unsure”: Age (per 1-year increase): 0.9 (0.7 to 1.1); P = NS |
|
| Race | Bastian20 | General population of insured women | Interested subjects age 40-45 years, 14% African American; Not interested, 3.3%; P = NS Interested subjects age 50-55 years, 12% African American: Not interested, 3.5%; P = NS |
|
| Melnikow28 | 5-year Gail score risk ≥ 1.7 | White subjects, 19% willing to try tamoxifen; African American, 40%; P = NS | ||
| Tjia32 | Women age 60-65 years with primary care provider | White subjects, 11% interested; African American, 10%; P = NS | “No interest” v “unsure”: Nonwhite v white: 1.1 (0.6 to 2.3); P = NS “Interested” v “unsure”: Nonwhite v white: 1.0 (0.3 to 3.0); P = NS |
|
| Education | Bastian20 | General population of insured women | Interested subjects age 40-45 years, 64% with college; not interested, 71%; P = NS | Interest, college, yes versus no: 1.0 (0.8 to 1.4) P = NS |
| Interested subjects age 50-55 years, 58% with college; not interested, 55%; P = NS | ||||
| Fashing22 | General population of women seeing gynecologist | Willingness to receive chemoprophylaxis according to educational level: | Willing to receive chemoprophylaxis: | |
| University entrance qualification: 50% willing | High school education v university entrance qualification: 1.5 (1.1 to 2.0); P < .004 | |||
| Basic secondary school: 63% | Basic secondary school v university entrance qualification: 1.7 (1.4 to 2.2); P < .0001 | |||
| Middle school: 54% | Middle school v university entrance qualification: 1.1 (0.9 to 1.3); P = NS | |||
| No school certificate: 60%; P < .001 | No school certificate v university entrance qualification: 1.6 (0.8 to 3.6); P = NS | |||
| Melnikow28 | 5-year Gail score risk > = 1.7 | Education less than high school, 27% willing to try tamoxifen; high school grad, 16%; some college or more, 17%; P = NS | Willing to try tamoxifen, high school grad or less v at least some college: 1.1 (0.3 to 4.3); P = NS | |
| Tjia32 | Women age 60-65 years with primary care provider | Education less than college graduate, 11% interested; college graduate, 11%; P = NS | ||
| Income | Bastian20 | General population of insured women | Interested subjects age 40-45 years, 90% with “adequate” income; not interested, 93%; P = NS | |
| Interested subjects age 50-55 years, 89% with “adequate income; not interested, 92%; P = NS | ||||
| Melnikow28 | 5-year Gail score risk ≥ 1.7 | Income < 200% federal poverty level, 30% willing to try tamoxifen; higher income, 15%; P < .05 | Willing to try tamoxifen, ≥ 200% federal poverty level v less: 4.7 (1.1 to 20); P < .05 | |
| Tjia32 | Women age 60-65 years with primary care provider | Income < $10,000/year: 45% subjects interested | ||
| $10,000-30,000: 14% | ||||
| $30,000-70,000: 12% | ||||
| > $70,000: 9%; P = .02 | ||||
| Health-related variables | ||||
| HRT use | Bastian20 | General population of insured women | Interested subjects age 40-45 years, 17% currently using HRT; not interested, 11%; P = NS | Interest: current HRT use, yes v no: 1.4 (1.0 to 2.0); P = .04 |
| Interested subjects age 50-55 years, 63% currently using HRT; not interested, 57%; P = NS | ||||
| Smoking | Bastian20 | General population of insured women | Interested subjects age 40-45 years, 30% currently smoking; not interested, 13%; P < .001 | Interest: currently smoking, yes v no: 1.9 (1.3 to 2.7); P < .001 |
| Interested subjects age 50-55 years, 20% currently smoking; not interested, 15%; P = NS | ||||
| Family history of stroke | Bober21 | 5-year Gail score risk ≥ 1.7 | Accepted tamoxifen/STAR trial: 25% with stroke family history; did not accept, 19%; P = NS | |
| History of oophorectomy | Julian-Reynier25 | Women attending cancer genetic clinic due to personal or family history of breast-ovarian cancer | Chemoprevention “acceptable”: Oophorectomy: yes v no: 0.3 (0.1 to 0.7); P < .01 | |
| Health status | Melnikow28 | 5-year Gail score risk ≥ 1.7 | Subjects willing to try tamoxifen, 69% with health status excellent or very good; 29% good, fair, or poor; Not willing, 67% excellent or very good; 27% good, fair, or poor; P < .05 | Interest: Good, fair or poor health status v very good or excellent: 0.7 (0.2 to 1.9); P = NS |
| Tjia32 | Women age 60-65 years with primary care provider | Interest by number of comorbid conditions: | Not interested v unsure: | |
| 0: 6% interested | Comorbid conditions per 1 increase: 1.1 (0.9 to 1.4); P = NS | |||
| 1-2: 12% | Interested v unsure: | |||
| > 2: 16%; P = NS | Comorbid conditions per 1 increase: 1.1 (0.8 to 1.4); P = NS | |||
| Breast cancer risk variables | ||||
| Gail score | Bastian20 | General population of insured women | Interested subjects age 40-45 years, 3% with 5-year Gail score ≥ 1.7; not interested, 3%; P = NS | Interest: 5-year Gail score ≥ 1.7, yes v no: 1.4 (0.8 to 2.3); P = NS |
| Interested subjects age 50-55 years, 16% with 5-year Gail score ≥ 1.7; not interested, 12%; P = NS | ||||
| McKay26 | Woman with atypia on breast biopsy, high risk for breast cancer, or interest in chemoprevention by patient or their physician | Mean 5-year Gail score of subjects accepting tamoxifen, 3.0%; declined tamoxifen, 3.8%; P = NS | Correlation of 5-year Gail score with acceptance of tamoxifen: coefficient 0.08, t = 2.4*; P = .02 | |
| Tjia32 | Women age 60-65 years with primary care provider | Not interested v unsure: Gail score > 1.66 v ≤1.66: 0.99 (0.6 to 1.6); P = NS Interested v unsure: Gail score > 1.66 v ≤1.66: 1.8 (0.8 to 3.8); P = NS |
||
| FDR with breast cancer | Bastian20 | General population of insured women | Interested subjects age 40-45 years, 14% with FDR with breast cancer; not interested, 8%; P = NS | |
| Interested subjects age 50-55 years, 19% with FDR with breast cancer, not interested, 13%; P = NS | ||||
| Family history of breast cancer | Melnikow28 | 5-year Gail score risk ≥ 1.7 | Subjects willing to try tamoxifen, 67% with family history of breast cancer; not willing, 57%; P = NS | |
| Bober21 | 5-year Gail score risk ≥ 1.7 | Accepted tamoxifen/STAR trial, 76% with breast cancer family history; did not accept, 74%; P = NS | ||
| Tjia32 | Women age 60-65 years with primary care provider | Interested subjects, 19% with family history of breast cancer; not interested, 33%; P = .04 | ||
| History of breast cancer | Julian-Reynier25 | Women attending cancer genetic clinic due to personal or family history of breast-ovarian cancer | Breast cancer, yes v no: 1.7 (1.0 to 3.0); P < .05 | |
| History of breast biopsy | Bober21 | 5-year Gail score risk ≥ 1.7 | Accepted tamoxifen/STAR trial, 76% history of breast biopsy; did not accept, 68%; P = NS | |
| Tjia32 | Women age 60-65 years with primary care provider | Interested subjects, 14% with history breast biopsy; not interested, 39%; P = NS | ||
| Abnormal biopsy | Bober21 | 5-year Gail score risk ≥ 1.7 | Accepted tamoxifen/STAR trial, 60% with abnormal breast biopsy; did not accept, 32%; P = .01 | |
| Goldenberg24 | Women who refused chemoprophylaxis but willing to have RPFNA; all with 5-year Gail score > 1.7%; atypical hyperplasia; LCIS; known BRCA mutation carrier; or prior DCIS | Acceptance of treatment according to result of RPFNA: Masood < 13: 0% Masood 14: 7% Masood > 15: 50%; P < .001 |
||
| Psychosocial variables: belief/expectancy | ||||
| Perceived vulnerability | Bastian20 | General population of insured women | Interested subjects age 40-45 years, 5% “likely or very likely to get breast cancer in the next 10 years”; not interested, 4%; P = NS | |
| Interested subjects age 50-55 years, 10% “likely or very likely to get breast cancer in the next 10 years”; not interested, 5%; P = NS Interested subjects age 40-45 years, estimate of “chance of getting breast cancer in the next 10 years,” 35%; not interested, 29%; P = .007 Interested subjects age 50-55 years, estimate of “chance of getting breast cancer in the next 10 years,” 35%; not interested, 30%; P = .05 Interested subjects age 40-45 years, 15% “likely or very likely to get breast cancer in the next 10 years, compared with other women of the same age”; not interested, 8%; P = .03 Interested subjects age 50-55 years, 15% “likely or very likely to get breast cancer in the next 10 years, compared with other women of the same age”; not interested, 7%; P = .005 |
Interest by perception high risk of breast cancer compared with others of same age (likely/very likely v others): 1.6 (1.0 to 2.6); P = .04 | |||
| Bober21 | 5-year Gail score risk ≥ 1.7 | Perceived vulnerability correlated with decision to take tamoxifen, F = 3.37†; P = .02 | ||
| Perceived breast cancer risk correlated with decision to take tamoxifen, F = 5.28; P < .001 | ||||
| Fashing22 | General population of women seeing gynecologist | Interest according to patient estimate of lifetime risk of general population: | Interest by patient's estimate of lifetime risk of general population: | |
| > 20%: 65% interested | > 20% v 1-5%: 1.6 (1.2 to 2.3); P = .002 | |||
| 10-20%: 57% | 10-20% v 1-5%: 1.2 (0.9 to 1.6); P = NS | |||
| 7-10%: 53% | Interest by patient's estimation of her own risk: | |||
| 5-7%: 54% | Average v none: 1.9 (1.3 to 2.9); P = .002 | |||
| 1-5%: 49%; P < .001 Interest according to patient's estimate of own lifetime risk: High: 74% interested Moderate: 56% Low: 50% None: 42%; P < .001 |
High v none: 3.7 (2.2 to 6.2); P < .0001 | |||
| Melnikow28 | 5-year Gail score risk ≥ 1.7 | Subjects willing to try tamoxifen, 73% self-perceived medium/high risk; not willing, 49%; P < .01 | Willing to try tamoxifen, self-perceived risk low v medium or high: 0.2 (0.1 to 0.7); P < .05 | |
| Meiser27 | Women of unknown mutation status from family of dominantly inherited susceptibility to breast cancer | Subjects considering tamoxifen, 56% mean perceived lifetime breast cancer risk; not considering tamoxifen, 46%; P = .006 | Interest: Each 10% change in perceived risk OR = 1.14 (1.002 to 1.30) for consideration of tamoxifen; P = .047 | |
| Tjia32 | Women age 60-65 years with primary care provider | Perception of breast cancer risk, 7-point Likert scale: | Not interested v unsure: | |
| Interested subjects: mean 4.1 | Risk perception per 1 point increase on Likert scale 0.7 (0.6 to 0.9); P = .002 | |||
| Not interest: 3.2; P = .001 | Interested v unsure: | |||
| Risk perception per 1 point increase on Likert scale 0.9 (0.6 to 1.2); P = NS | ||||
| Belief regarding medication effectiveness | Bober21 | 5-year Gail score risk ≥ 1.7 | Belief that medication won't prevent cancer correlated with decision not to take tamoxifen, F = 6.22, P = .001 | |
| Melnikow28 | 5-year Gail score risk ≥ 1.7 | Subjects willing to try tamoxifen, 82% very or moderately confident that tamoxifen reduces breast cancer; not willing, 40%; P < .001 | Willingness to try tamoxifen, confidence in tamoxifen to reduce cancer risk very or moderately high v less: 4.4 (1.6 to 12); P < .05 | |
| Psychosocial variables: values/goals | ||||
| Concern about side effects | Bober21 | 5-year Gail score risk ≥ 1.7 | Concern about side effects correlated with decision not to take tamoxifen, F = 4.28, P < .006 | |
| Melnikow28 | 5-year Gail score risk ≥ 1.7 | Subjects willing to try tamoxifen, 22% hot flashes very/moderately important; not willing, 44%; P < .01 | Willing to try tamoxifen: | |
| Subjects willing to try tamoxifen, 22% cataracts very/moderately important; not willing, 58%; P < .001 | Sexual dysfunction moderate or very important v less: 0.2 (0.04 to 0.9); P < .05 | |||
| Subjects willing to try tamoxifen, 60% pulmonary embolism very/moderately important; not willing, 88%; P < .001 | Cataracts very or moderately important v less: 0.3 (0.1 to 0.99); P < .05 | |||
| Subjects willing to try tamoxifen, 91% fractures very/moderately important; not willing, 57%; P < .001 | Blood clot in lung very or moderately important v less: 0.3 (0.1 to 0.9); P < .05 | |||
| Fractures very important v less: 5.4 (2.0 to 15); P < .05 | ||||
| Psychosocial variables: emotional/affective | ||||
| Depression | Bastian20 | General population of insured women | Interested subjects age 40-45 years, 38% CES-D score ≥ 10; not interested, 24%; P = .003 Interested subjects age 50-55 years, 27% CES-D score ≥ 10; not interested, 25%; P = NS |
Interest: CES-D score ≥ 10 v < 10: 1.3 (1.0 to 1.8); P = NS |
| Breast cancer worry | Bastian20 | General population of insured women | Interested subjects age 40-45 years, 10% “worried about getting breast cancer in the next 10 years”; not interested, 3%; P = .001 Interested subjects age 50-55 years, 10% “worried about getting breast cancer in the next 10 years”; not interested, 3%; P = .001 |
Interest: worry about breast cancer (worried/very worried v others): 3.5 (1.9 to 6.5); P < .001 |
| Tjia32 | Women age 60-65 years with primary care provider | Breast cancer worry, 7-point Likert scale: | Not interested v unsure: | |
| Interested subjects: mean 3.2 | Worry per 1 point on Likert scale: 0.7 (0.5 to 0.9); P = .005 | |||
| Not interested: 1.8; P = .03 | Interested v unsure: Worry per 1 point on Likert scale 2.1 (1.4 to 2.8); P = .001 |
|||
| Intrusive thinking | Bober21 | 5-year Gail score risk ≥ 1.7 | Intrusive thinking correlated with decision to take tamoxifen, F = 7.67, P = .0001 | |
| Information source | ||||
| Gynecologist recommendation | Bober21 | 5-year Gail score risk ≥ 1.7 | Accepted tamoxifen/STAR trial: Physician recommendation: 87% Did not accept: Physician recommendation: 40%; P = .0001 |
|
| Fashing22 | General population of women seeing gynecologist | Gynecologist source of breast cancer information, 59% willing to receive chemoprophylaxis; other physician, 52%; P < .001 | Interest: source of information about breast cancer from gynecologist, yes v no: 1.3 (1.1 to 1.5); P = .002 | |
| Medical books | Fashing22 | General population of women seeing gynecologist | Medical books source of breast cancer information, 54% willing to receive chemoprophylaxis; not medical books, 56%; P = NS | Interest by source of information medical books, yes v no: 0.8 (0.65 to 0.95); P = .01 |
| Medical brochures | Fashing22 | General population of women seeing gynecologist | Medical brochures source of breast cancer information, 58% willing to receive chemoprophylaxis; not brochures, 54%; P = .001 | Interest by source of information medical brochures, yes v no: 1.2 (1.0 to 1.4); P = .02 |
Abbreviations: FDR, first-degree relative; NS, not significant; HRT, hormone replacement therapy; CES-D, Center for Epidemiologic Studies–Depression scale; RPFNA, random periareolar fine-needle aspiration; DCIS, ductal carcinoma in situ; LCIS, lobular carcinoma in situ.
*
Linear regression.
†
Analysis of variance.