Postmenopausal women who find themselves diagnosed with estrogen-positive disease are often prescribed aromatase inhibitors (AI) for risk reduction. This classification of therapy has had great success in reducing recurrence in many patients. However, a recent study points to the fact that many women are not offered bone density assessment prior to the start of treatment which can have devastating long-term sequelae.
Using data from the Centers for Medicare and Medicaid Services Parts A, B, and D, claims were used to identify a cohort of women aged 67 years and older with incident breast cancer in 2006 and 2007 who started AI therapy. Approximately two-thirds of patients had baseline bone density testing. Older age, comorbidity, low income, and black race were associated with lower rates of baseline bone density testing. The proportion of women who had neither bone density testing nor bisphosphonate therapy increased with age as well.1
Despite the risk factors associated with AI use, older women are less likely to undergo assessment for bone density.
We often discuss the use of AIs in our weekly tumor board and I am curious to see how often women are screened with a bone density exam prior to the start and at intervals during their survivorship years.
At a time when we are exploring opportunities for personalized medical care, healthcare providers must use suitable management for bone health given this subset of patients.
Charlson J, Smith EC, Smallwood AJ, et al. Bone Mineral Density Testing Disparities Among Patients With Breast Cancer Prescribed Aromatase Inhibitors. J Natl Compr Canc Netw. 2016 Jul;14(7):875-80.
Male breast cancer accounts for about 1% of all breast cancer cases in the United States, therefore it can be a shocking diagnosis. During my career as a nurse practitioner in the field of breast oncology, I have been involved in the care of only five male breast cancer cases over the last 25 years.
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