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Tamoxifen For Breast Cancer Chemoprevention: Low Uptake by High-Risk Women After Evaluation of a Breast Lump

¹ Division of General Surgery, University of Ottawa, Ottawa, Ontario, Canada
² Division of General Surgery, Queen’s University, Kingston, Ontario, Canada

CORRESPONDING AUTHOR: Rebecca Taylor, MD, MSc, #1-35 Rosebery Ave, Ottawa, Ontario, K1S 1W1, beccaanntaylor{at}hotmail.com

PURPOSE The Breast Cancer Prevention Trial (BCPT) published results in 1998 showing that the use of tamoxifen in high-risk women reduced the incidence of invasive breast cancer by 49%. We examined the clinical impact of the BCPT to determine whether high-risk women informed of these results would use tamoxifen for chemoprophylaxis and to investigate the factors influencing this decision.

METHODS Of 345 women evaluated for a breast lump at a referral center, 89 were defined as high risk for but did not currently have cancer. These women were contacted about their elevated risk and informed that there exists a medication proved to reduce this risk. They were encouraged to discuss the issue with their family physician, to whom we sent copies of the 3 largest tamoxifen chemoprevention studies, including the BCPT. Follow-up was conducted by telephone to determine each woman’s choice regarding tamoxifen use for chemoprevention and to ascertain her reasons for reaching this decision.

RESULTS Of the 89 high-risk women, 1 decided to take tamoxifen for breast cancer chemoprevention. Only 48 women discussed tamoxifen with their family physician; in 3 cases (3.4%) the family physician recommended that the patient start taking tamoxifen, in 8 cases (9.1%) the family physician made no recommendations, and in 37 cases (42%) the family physician advised against tamoxifen. The most frequently cited factors influencing the decision not to start tamoxifen were a fear of adverse events (46.8%), the family physician’s recommendation (31.9%), and a perceived low breast cancer risk (34%).

CONCLUSION Family physicians recommended prophylactic tamoxifen to few women and even fewer women chose to take it. The major barrier appears to be concern about potential adverse effects of tamoxifen.

Key Words: Breast neoplasms • tamoxifen • anticarcinogenic agents • chemoprevention • BCPT trial

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