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Diffusion of aromatase inhibitors for breast cancer therapy between 1996 and 2003 in the Cancer Research Network

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Clinical trials demonstrated adjuvant aromatase inhibitor treatment is superior for decreasing breast cancer recurrence risk over adjuvant tamoxifen treatment as early as 2001. Yet clinical use for adjuvant treatment was not recommended by the American Society of Clinical Oncology until 2004. Aromatase inhibitor uptake after the first public presentation of randomized trial results but before the release of national guidelines is unclear. We evaluated diffusion of aromatase inhibitor dispensings for breast cancer treatment in integrated healthcare delivery systems across the United States.

Methods

We collected automated data for 13,245 women enrolled at seven integrated healthcare delivery systems in the Cancer Research Network. All women were aged >55 and diagnosed with estrogen receptor positive, invasive breast cancer between 1996 and 2003. We used electronic pharmacy data to identify aromatase inhibitor and tamoxifen dispensings through 2004. We evaluated the proportions of women who received hormone dispensings in two ways: (1) at any point after diagnosis to capture all use, and (2) in the two-year period following diagnosis to approximate adjuvant use.

Results

Over time, adjuvant aromatase inhibitor use increased whereas tamoxifen use decreased. Aromatase inhibitor dispensings within 2 years of diagnosis increased from 4.1% among women diagnosed in 2000 to 13% in 2001, 24% in 2002, and 40% in 2003. Tamoxifen use declined starting in 2001 at every system.

Conclusion

Aromatase inhibitor use rose dramatically after 2001 while tamoxifen use decreased. It appears results from early clinical trials changed practice in these integrated healthcare systems before formal changes in national guidelines.

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Acknowledgments

The overall goal of the CRN is to increase the effectiveness of preventive, curative and supportive interventions that span the natural history of major cancers among diverse populations and health systems, through a program of collaborative research. The 11 health systems, with nearly 10 million enrollees, are distinguished by their long-standing commitment to prevention and research, and collaboration among themselves and with affiliated academic institutions. We would like to acknowledge the principal investigator at each site for their support of this project and management of data collection at their site: Terry Field (Meyers Primary Care Institute), Suzanne Fletcher (Harvard Pilgrim Health Care), Lisa Herrinton (Kaiser Permanente Northern California), Mark Hornbrook (Kaiser Permanente Northwest), Chris Johnson (Henry Ford Health System), Judy Mouchawar (Kaiser Permanente Colorado), Virginia Quinn (Kaiser Permanente Southern California), Sharon Rolnick (HealthPartners Research Foundation), Dennis Tolsma (Kaiser Permanente Georgia), Tom Vogt (Kaiser Permanente Hawaii), and Ed Wagner (Group Health Center for Health Studies).

We also thank Roy Pardee from Group Health Center for Health Studies and Karen Wells from Henry Ford Health System for their work on this study.

Research support: This work was funded by the National Cancer Institute (U19 CA 79689). Dr. Buist’s time was supported by a grant from the American Cancer Society (CRTG-03-024-01-CCE).

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Authors and Affiliations

  1. Group Health Center for Health Studies, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA

    Erin J. Aiello, Diana S. M. Buist, Edward H. Wagner, Leah Tuzzio, Sarah M. Greene & Gene Hart

  2. School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA

    Diana S. M. Buist

  3. Henry Ford Health Systems, Detroit, MI, USA

    Lois E. Lamerato

  4. Meyers Primary Care Institute, University of Massachusetts, Worcester, MA, USA

    Terry S. Field

  5. Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

    Lisa J. Herrinton

  6. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

    Reina Haque

  7. Kaiser Permanente Colorado, Denver, CO, USA

    Kimberly J. Bischoff

  8. Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Salem-Winston, NC, USA

    Ann M. Geiger

Authors
  1. Erin J. Aiello
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  2. Diana S. M. Buist
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  3. Edward H. Wagner
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  4. Leah Tuzzio
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  5. Sarah M. Greene
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  6. Lois E. Lamerato
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  7. Terry S. Field
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  8. Lisa J. Herrinton
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  9. Reina Haque
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  10. Gene Hart
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  11. Kimberly J. Bischoff
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  12. Ann M. Geiger
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Corresponding author

Correspondence to Erin J. Aiello.

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Aiello, E.J., Buist, D.S.M., Wagner, E.H. et al. Diffusion of aromatase inhibitors for breast cancer therapy between 1996 and 2003 in the Cancer Research Network. Breast Cancer Res Treat 107, 397–403 (2008). https://doi.org/10.1007/s10549-007-9558-z

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  • DOI: https://doi.org/10.1007/s10549-007-9558-z

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