Background: Preventive medication treatments have been found to be effective in reducing the risk of breast cancer (BC), but the uptake of such medication treatments for primary BC prevention among high-risk individuals remains suboptimal, often below 5%.
Objectives: This systematic review evaluated the effectiveness of various interventions designed to improve the uptake of preventive medication treatments for populations with high risk for BC.
Methods: We systematically searched MEDLINE, Web of Science, and PsychINFO databases for clinical trials and observational studies that evaluated the impact of interventions on various preventive medication treatment uptake among populations with high risk for BC from inception until January 14th, 2025.
Results: Of 873 publications identified, 742 abstracts were screened after removing duplicates, and 15 full-text articles met the inclusion criteria for this systematic review. Educational and consultation-based intervention (46.67%), including structured counseling sessions on BC risk and preventive medication treatments, consistently improved the knowledge but resulted in a modest uptake rate. Factors such as concerns about adverse effects and low perception of BC risk deterred the participants. Decision aid (DA) interventions (46.67%), including web-based tools such as Guide to decide and RealRisk, significantly enhanced informed-decision making (e.g., 52.7% vs 5.9%, P<0.001) with a limited impact on the uptake rates (e.g., 3.5% vs 2.1%, P=0.735). Combination of standard educational session with personalized genetic counseling or polygenic risk score (PRS) estimate for BC risk, demonstrated knowledge improvement and alignment between perceived and actual risk, where PRS significantly increased the uptake of BC preventive medication treatments (53.4% vs. 20.9%, P< 0.001). System-level intervention targeting communication and prescribing behavior of the healthcare providers achieved significantly higher acceptance and adherence rates, specifically observed among participants who were newly diagnosed with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS) on long-term follow-up (76% vs 48%, P<0.01). Other interventions, such as web-based protection motivation theory (PMT) and risk communication tools, modestly facilitate the clinical action and intention toward BC preventive medication treatments.
Conclusions: Decision aid and educational interventions aiming to improve the uptake of preventive medication treatments for BC consistently improved knowledge and decision-making, but did not improve actual treatment uptake among high-risk populations for BC. Future research is needed to develop and validate more refined personalized interventions.
