Beliefs About Medication and Uptake of Preventive Therapy in Women at Increased Risk of Breast Cancer: Results From a Multicenter Prospective Study

Abstract

Introduction Uptake of preventive therapies for breast cancer is low. We examined whether women at increased risk of breast cancer can be categorized into groups with similar medication beliefs, and whether belief group membership was prospectively associated with uptake of preventive therapy. Patients and Methods Women (n = 732) attending an appointment to discuss breast cancer risk were approached; 408 (55.7%) completed the Beliefs About Medicines and the Perceived Sensitivity to Medicines questionnaires. Uptake of tamoxifen at 3 months was reported in 258 (63.2%). The optimal number of belief groups were identified using latent profile analysis. Results Uptake of tamoxifen was 14.7% (38/258). One in 5 women (19.4%; 78/402) reported a strong need for tamoxifen. The model fit statistics supported a 2-group model. Both groups held weak beliefs about their need for tamoxifen for current and future health. Group 2 (38%; 154/406 of the sample) reported stronger concerns about tamoxifen and medicines in general, and stronger perceived sensitivity to the negative effects of medicines compared with group 1 (62%; 252/406). Women with low necessity and lower concerns (group 1) were more likely to initiate tamoxifen (18.3%; 33/180) than those with low necessity and higher concerns (group 2) (6.4%; 5/78). After adjusting for demographic and clinical factors, the odds ratio was 3.37 (95% confidence interval, 1.08-10.51; P = .036). Conclusion Uptake of breast cancer preventive therapy was low. A subgroup of women reported low need for preventive therapy and strong medication concerns. These women were less likely to initiate tamoxifen. Medication beliefs are targets for supporting informed decision-making.

Preferences of Patients and At-risk Individuals for Preventive Approaches to Rheumatoid Arthritis

“…Fewer than 25% of women at high risk for breast cancer are willing to take preventive hormonal treatment. Effective uptake of medication is even lower 28 , and predicted by patients' beliefs about medicine 34 . Acceptance of treatment for osteoporosis is somewhat higher, but still only about half of post-menopausal women would accept preventive medication at the recommended fracture risk threshold.…”

Understanding low chemoprevention uptake by women at high risk of breast cancer: findings from a qualitative inductive study of women’s risk-reduction experiences

“…The substantial proportion of women who knew about chemoprevention but were not inclined to pursue it, however, articulated a range of overlapping reasons for their reluctance, from lack of information (about side effects, long-term health risks, or effectiveness) to semi-confident preferences (to avoid medication or pursue alternate risk-reduction approaches). The reluctance to use any medication at all (see also [ 32 , 33 ]) is not generally consistent with the use of medication in the U.S. overall, or with the far more substantial uptake of other preventive medications (such as statins). Furthermore, women’s assessment of chemoprevention as more drastic than prophylactic surgery and potentially having very acute and serious side effects suggests that perhaps women fear chemotherapy-like experiences while on chemoprevention, despite rare evidence that this occurs [ 58 , 59 ].…”

“…In addition, while lack of awareness and insufficient knowledge are among the top known barriers to chemoprevention uptake [ 14 , 30 , 37 ], few studies have examined how women who are aware of chemoprevention differ from those who are not. The vast majority of chemoprevention studies have also relied on samples of predominantly White participants, underrepresenting or nearly excluding women of other racial/ethnic backgrounds [ 24 , 33 , 34 , 38 ]. Awareness of this problem has begun to cause a shift, with a few studies beginning to enroll more multi-racial participant groups [ 19 , 25 , 35 , 39 ].…”

Finding the five‐year window: A qualitative study examining young women's decision‐making and experience of using tamoxifen to reduce BRCA1/2 breast cancer risk

“…Declining tamoxifen due to the intention to conceive was also cited by Skandarajah et al describing 15% (25/168) of women attending the risk management clinic at the Royal Melbourne Hospital, Australia, who had preventive endocrine therapy discussed with them 35 . Nevertheless, the heterogeneous samples of these studies were not described in enough detail to identify the perspectives of women with a BRCA1/2 mutation or these women were not included in the qualitative data collection at all, and participants were older on average than the young women in this study 31,35,36 …”

“…There have been a number of mixed‐method studies that provide some context to decision‐making about tamoxifen by women more generally who are at increased risk of breast cancer (moderate and high risks) 31,35,36 . These studies consistently record that one of the reasons women declined tamoxifen was due to concerns about side effects 31,35,36 .…”