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

Rebecca Taylor; Kenneth Taguchi

doi:10.1370/afm.284

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Figure 1.
Study design.

^* Risk as defined by Gail model.⁴

^† Net benefit as determined by risk/benefit algorithm.¹⁰
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Figure 2.
Classification of high-risk women by presence or absence of a uterus, age, and projected 5-year risk of invasive breast cancer.

From Gail MH, Constantino JP, Bryant J, Croyle R, Freedman L, Helzlsouer K, Vogel V. Weighing the risks and benefits of tamoxifen treatment for prevention. J Natl Cancer Inst 1999;91:1829–1846.

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Table 1.

Study Participant Characteristics

Characteristic	No.	%
Age, y
40–49	11	12
50–59	18	20
60–69	33	37
70–80	27	30
Menopausal status
Premenopausal	16	18
Postmenopausal	73	82
Previous hysterectomy
Yes	35	39
No	54	61
First degree relative(s) with breast cancer
Yes	37	42
No	52	58
History of atypical hyperplasia in the breast
Yes	3	3
No	86	97
5-year predicted breast cancer risk,⁴ %
<2.00	49	55
2.01–3.00	20	22
3.01–5.00	15	17
>5.00	5	5
Evidence for a net benefit with tamoxifen¹⁰
No evidence	16	18
Moderate evidence	3	3
Strong evidence	70	79
Total	89	100

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Table 2.

Physician Recommendation, Decision to Take Tamoxifen, and Factors Influencing This Decision Among 48 Women Who Discussed Taking Tamoxifen With Their Family Physician

Question	No.	%
* Women were permitted to identify more than 1 factor influencing their decision to take tamoxifen; therefore, the number of reasons does not equal the number of women. The percentage value indicates the number of women identifying that factor among the 48 women.
† The specific adverse events of concern to respondents included thromboembolic disease, uterine cancer, and such symptoms as hot flushes.
Family physician recommendation
Recommended tamoxifen	3	6
No recommendation	8	17
Recommended against tamoxifen	37	77
Women’s decision
Take tamoxifen	1	2
Not to take tamoxifen	47	98
Total no. of women	48	100
Factors influencing decision*
Fear of adverse effects^†	22	46
Risk not high enough	16	33
Family physician’s decision	15	31
Personal decision	12	25
Lack of sufficient data	5	10
Total number of reasons	70

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Supplemental Appendix

Supplemental Appendix. Additional Considerations for the Decision to Use Tamoxifen for Breast Cancer Prophylaxis

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Supplemental data: Appendix - PDF file, 3 pages, 88 KB
The Article in Brief

Background: Tamoxifen, a drug used to treat breast cancer, has also been shown to help prevent breast cancer in women at high risk for the disease. However, it has potentially serious side effects. The purpose of this study was to determine whether women are taking tamoxifen to prevent breast cancer and to understand the reasons for their decisions.
What This Study Found: The study included 89 women who were identified as being at high risk for breast cancer. The women were told about tamoxifen and encouraged to discuss the issue with their family physician. Of the 89 women in the study, only 1 decided to take tamoxifen for preventive purposes. Forty-eight women discussed tamoxifen with their family physician. In 3 cases, the family physician advised taking tamoxifen. In 8 cases, the family physician made no recommendation. In 37 cases, the family physician advised against taking tamoxifen. The most common reasons why women didn�t take tamoxifen were fear of serious side effects, the perception that they were at low risk for breast cancer, and the lack of recommendation by their doctor.
Implications:
* Women at high risk for breast cancer as well as family physicians appear to be concerned about the potential side effects of taking Tamoxifen for breast cancer prevention.
* A family physician�s opinion is a key factor in the decision to not use Tamoxifen.
* Women who are at high risk for breast cancer need information to help weigh the risks and benefits of using Tamoxifen for preventive purposes.