ArticleCancer prevention research (Philadelphia, Pa.)2026
Factors Associated with Low-Dose Tamoxifen Use among Women with Atypical Hyperplasia or Lobular or Ductal Carcinoma In Situ.
Article in Cancer prevention research (Philadelphia, Pa.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
In 2019, professional guidelines incorporated low-dose tamoxifen as an option for breast cancer chemoprevention among women with atypical hyperplasia (AH) or lobular or ductal carcinoma in situ (LCIS/DCIS). We assessed factors associated with low-dose tamoxifen use among women diagnosed with AH, LCIS, or DCIS from 2016 to 2019 and from 2020 to 2023 compared with full-dose selective estrogen receptor modulators (SERM) or aromatase inhibitors (AI) at Columbia University Irving Medical Center in New York City. Uni- and multivariable logistic regression were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for variables associated with low-dose tamoxifen use. Among 2,260 evaluable women, 834 (36.9%) initiated a SERM or AI, and 140 (6.2%) took low-dose tamoxifen. Comparing women diagnosed before or after 2019, chemoprevention uptake significantly increased (33.9% vs. 39.3%, P = 0.008), particularly low-dose tamoxifen (3.3% vs. 8.6%). Among women who initiated chemoprevention, diagnosis of high-risk breast lesions before age 50 (OR = 3.02; 95% CI, 1.99-4.58), diagnosis after 2019 (OR = 2.83; 95% CI, 1.81-4.41), AH/LCIS versus DCIS (OR = 2.90; 95% CI, 1.95-4.31), and medical oncology referral (OR = 1.61; 95% CI, 1.02-2.54) were significant predictors of low-dose tamoxifen use. Those who initiated low-dose tamoxifen as their first chemoprevention had the lowest 1-year discontinuation rate (24.3%) compared with full-dose SERMs/AIs (32.3%-37.9%, P = 0.027). Since 2019, we observed a significant increase in low-dose tamoxifen use and chemoprevention uptake overall. Among women who initiated chemoprevention, low-dose tamoxifen uptake was higher among younger women and those with less advanced breast lesions. Low-dose options of proven chemopreventive agents may increase acceptance of risk-reducing medications for breast cancer prevention. PREVENTION RELEVANCE: This study provides evidence of increased use of low-dose tamoxifen in a prevention setting, particularly among younger women and those with less advanced breast lesions. Further research is needed to understand how to incorporate low-dose tamoxifen into patient-provider discussions to improve chemoprevention decision-making.
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