Breast cancer

Chemoprevention of breast cancer could be championed more


More women at increased risk of breast cancer could be encouraged to consider tamoxifen chemoprevention with a positive recommendation from their doctor.

In a systematic review of the motivators and barriers to tamoxifen use, a health professional’s recommendation was identified as influential in a women’s decision.

Tamoxifen can reduce the risk of breast cancer by up to 50% in women at high risk due to hereditary breast cancer, the review said.

Lead author Professor Bettina Meiser, head of the Psychosocial Research Group at the Prince of Wales Clinical School, said many studies had shown the role of a doctor’s recommendation in screening and preventive behaviours.

“It’s quite well known that a health practitioner’s recommendation is a very important factor.  Of course a GP or other doctor would need to be aware it is a value sensitive decision for that particular woman.”

Professor Meiser told the limbic women’s perceptions about the drug were also influenced by their observations of tamoxifen being used to treat family members with breast cancer.

“So it is the association with a treatment for breast cancer that concerns women and that has certainly been found in a number of studies,” she said.

“And they may not want to take medication on a daily basis which serves as a reminder of their increased risk and a reminder of the treatment experiences their relatives had.”

The review found some women were not willing to take tamoxifen for risk reduction due to concerns about its potential side effects.

Yet they did not place as much weight on the downsides of surgical strategies such as the loss of fertility and sudden onset of menopause with bilateral oophorectomy or the risk of unsatisfactory cosmetic results with prophylactic mastectomy.

Professor Meiser said a woman’s individual tolerance of uncertainty would also influence any decisions between risk reducing surgery and chemoprevention.

She said women at the highest risk of breast cancer would have received genetic counseling and information on risk management strategies at familial cancer clinics.

However a much larger group of women at moderately increased risk of breast cancer weren’t seen at specialised clinics and were possibly unaware of options including tamoxifen and modifying lifestyle risk factors such as alcohol consumption.

Professor Meiser said women needed access to accurate information about their risk of breast cancer and time to consider their options.

She said decision support tools could be very valuable in discussions between clinicians, their patients and family members.

“It’s a decision where personal values need to be taken into account to arrive at a decision that is right for the woman given the pros and cons of tamoxifen.”

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