Older women most at risk for bone fractures may not be receiving recommended bone density assessments prior to receiving aromatase inhibitor (AI) treatment for breast cancer, according to a study published in the Journal of the National Comprehensive Cancer Network.
AIs, drugs that halt the production of estrogen in women, are a part of standard adjuvant therapy for post-menopausal women with hormone-receptor positive breast cancer. However, while AIs are often an effective treatment regimen for this patient population, they may also increase one’s risk of factures, which is why the National Comprehensive Cancer Network recommends that patients undergo bone mineral density (BMD) testing before beginning treatment with AIs.
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To determine how often institutions are actually complying with these recommendations, researchers led by John Charlson, MD, Medical College of Wisconsin (Milwaukee, WI), conducted a study looking at Medicare Parts A, B, and D claims data to see how women aged 67 years and older were treated with AI therapy between 2006 and 2007.
Overall, researchers found that about two-thirds of patients received recommended baseline BMD testing. Presence of comorbidities, low income, and black race were all associated with lower rates of baseline bone density testing, with older age being the greatest correlate. Indeed, testing rates fell significantly from 73% in women ages 67-70 years to 51% in those over the age of 85 years. This is directly opposite of what the NCCN guidelines currently suggest.
"The oldest patients are most likely to be vulnerable to bone density loss, so BMD testing results may be especially important in this age group for analysis of risks and benefits of treatment, as well as to determine whom should be treated with bone-modifying agents," said Dr Charlson.
Researchers concluded that despite being an important risk factor for fractures, older women starting treatment with AIs may be less likely to receive recommended bone density assessment.
"This study highlights sub-optimal U.S. compliance with guideline recommendations for baseline BMD testing when starting AI therapy," Dr Charlson added. "Older women, at higher risk for fractures in general, are least likely to get testing, and the slight increase in empiric treatment in no way closes the gap."
