Breast Cancer

Biography

Biography: Jamal Zekri

Abstract

Introduction: Adjuvant Aromatase Inhibitors (AIs) predispose breast cancer patients to accelerated bone loss. Consensus guidelines recommend screening and follow of bone mineral density (BMD) with dual energy X-ray absorptiometry (DEXA) scan in this setting. In this study we assessed the rate of adherence to these guidelines and introduced awareness measures to improve it. Methods: We conducted a single centre, retrospective study in patients who started adjuvant AIs for invasive breast cancer. As per World Health Organization criteria, normal BMD, osteopenia and osteoporosis were defined as T scores of >-1, -1 to >-2.5, and ≤-2.5 respectively. In addition, we measured the frequency of therapeutic intervention at T score cut-off of <-2 as recommended by most guidelines. Subsequently, 4 awareness sessions were conducted to encourage physicians to request a base line DEXA scan for new patients starting adjuvant AIs. The practice was re-audited 5 months later. Results: 554 women with early breast cancer on adjuvant hormonal therapy were identified. 367 of these patients were on AIs and are the subject of this report. Baseline DEXA scan was performed in 188 (51.2%) patients. Of these, 24 (12.8%) had normal BMD, 106 (56.4%) had osteopenia and 58 (30.8%) had osteoporosis. Therapeutic bisphosphonates were administered to 83 (78.3%) osteopenic and 41 (70.7%) osteoporotic patients. 89 patients had T score <-2, of whom 67(75.3%) received bisphosphonates. 40 out of these 89 (44.9%) had follow up DEXA scans.Twenty two new patients started AIs within the 5 months after the awareness sessions. All 22 (100%) had a DEXA scan requested Conclusion: This study of a sizable cohort adds to limited previous observations that adherence to skeletal health guidelines in this patient population is less than adequate. Adherence is improved dramatically by raising the awareness of relevant physicians.