Qualitative study of perception of chemoprevention among women at high risk for breast cancer

Breast cancer (BC) chemoprevention (CP) is highly effective in reducing invasive BC risk, yet uptake among eligible women at high risk remains critically low. Prior research has not adequately examined CP decision-making alongside other primary prevention therapies, such as statins, in the practical context of multimorbidity and polypharmacy. An exploratory qualitative study at Columbia University (New York, NY) aimed to identify cognitive, emotional, and perceptual factors associated with accepting statins while declining or deferring BC CP. In-depth semistrutured interviews were conducted with women aged 40 to 79 years at elevated risk for BC. Interviews focused on experiences with and perceptions of both BC CP and statin therapy. Among 17 women at high risk for BC (mean age 54.5 years, SD 10.6), three overarching categories of themes were identified: (1) risk framing, (2) trade-offs, and (3) pathway complexity. Statins were commonly framed as routine, low-burden, measurable interventions that fit easily into a familiar model of preventive care. In contrast, BC CP was often perceived as high-burden, uncertainty-heavy, identity-relevant treatment with benefits experienced as probabilistic, long-term, and invisible. This assymetry was amplified by multimorbidity and polyfarmacy, contributing to treatment fatigue and fragmented clinical pathways in which statins receive clear, prescriptive guidance; however, BC CP is offered through nondirective, complex discussions across multiple specialists. The authors conclude that these findings suggest that clearer communication, framing BC CP as a familiar risk-reducing medication, presenting it as a reversible, time-limited treatment, and integrated decision support, may increase appropriate uptake.