Uptake of tamoxifen in consecutive premenopausal women under surveillance in a high-risk breast cancer clinic

• Published in: British journal of cancer Vol. 110; no. 7; pp. 1681 - 1687
• Main Authors: Donnelly, L S, Evans, D G, Wiseman, J, Fox, J, Greenhalgh, R, Affen, J, Juraskova, I, Stavrinos, P, Dawe, S, Cuzick, J, Howell, A
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-04-2014; Nature Publishing Group
• Subjects: 692/699/67/1059/99; 692/699/67/1347; 692/699/67/2195; Adult; Antineoplastic Agents, Hormonal - administration & dosage; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Birth control; Breast cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - prevention & control; Cancer Care Facilities; Cancer Research; Clinical Study; Decision Making; Disease prevention; Drug Resistance; Epidemiology; Family medical history; Female; Gynecology. Andrology. Obstetrics; Hospitals; Humans; Interviews as Topic; Mammary gland diseases; Mammography; Medical research; Medical sciences; Middle Aged; Molecular Medicine; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Oncology; Premenopause - drug effects; Preventive medicine; Randomized Controlled Trials as Topic; Risk Factors; Surveillance; Tamoxifen - administration & dosage; Tumors; Women - psychology; Womens health; United Kingdom > UK; United States > US; breast cancer; uptake; qualitative; tamoxifen; prevention; Human; Antineoplastic agent; High risk; Breast disease; Premenopause; Antiestrogen; Breast cancer; Antihormone; Malignant tumor; Tamoxifene; Prevention; Mammary gland diseases; Selective estrogen receptor modulator; Cancerology; Surveillance; Young adult; Female; Woman; Non steroid compound; Cancer
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/bjc.2014.109

Background:
Randomised trials of tamoxifen versus placebo indicate that tamoxifen reduces breast cancer risk by approximately 33%, yet uptake is low. Approximately 10% of women in our clinic entered the IBIS-I prevention trial. We assess the uptake of tamoxifen in a consecutive series of premenopausal women not in a trial and explore the reasons for uptake through interviews.
Methods:
All eligible women between 33 and 46 years at ⩾17% lifetime risk of breast cancer and undergoing annual mammography in our service were invited to take a 5-year course of tamoxifen. Reasons for accepting (
n
=15) or declining (
n
=15) were explored using semi-structured interviews.
Results:
Of 1279 eligible women, 136 (10.6%) decided to take tamoxifen. Women >40 years (74 out of 553 (13.4%)) and those at higher non-
BRCA
-associated risk were more likely to accept tamoxifen (129 out of 1109 (11.6%)). Interviews highlighted four themes surrounding decision making: perceived impact of side effects, the impact of others’ experience on beliefs about tamoxifen, tamoxifen as a ‘cancer drug’, and daily reminder of cancer risk.
Conclusions:
Tamoxifen uptake was similar to previously ascertained uptake in a randomised controlled trial (IBIS-I). Concerns were similar in women who did or did not accept tamoxifen. Decision making appeared to be embedded in the experience of significant others.