Patient Decisions About Breast Cancer Chemoprevention: A Systematic Review and Meta-Analysis

Abstract

A B S T R A C T PurposeWomen at high risk of breast cancer face the complex decision of whether to take tamoxifen or raloxifene for breast cancer chemoprevention. We investigated what is known about decisions of women regarding chemoprevention. MethodsUsing MEDLINE, CINAHL, and PSYCINFO, plus reviewing reference lists of relevant articles, in December 2009 we identified 13 studies that addressed patient decisions about breast cancer chemoprevention, were published in 1995 or later, were peer-reviewed primary clinical studies, and reported rates at which participants showed interest in (hypothetical uptake) or accepted (real uptake) chemoprevention medications. ResultsNine studies provided information about hypothetical breast cancer chemoprevention decisions (mean uptake rate, 24.7%) and five provided information about real decisions (mean uptake rate, 14.8%). The range of rates was wide, and each of the hypothetical uptake studies assessed interest differently. A logistic regression model found significant correlation with uptake of decision type (hypothetical versus real, odds ratio [OR] ϭ 1.65; 95% CI, 1.26 to 2.16), educational or decision support intervention (provided v not, OR ϭ 0.21; 95% CI, 0.17 to 0.27), and cohort risk for breast cancer (high-risk v general population, OR ϭ 0.65; 95% CI, 0.56 to 0.75). Perceived vulnerability to breast cancer was consistently correlated with increased uptake, and concern for adverse effects was correlated with reduced uptake. All studies used a correlational/descriptive design, and most studies used convenience sampling strategies. ConclusionBreast cancer chemoprevention uptake rates are low and variation is wide. Hypothetical uptake rates are higher than real uptake, and interventions markedly reduce uptake. Research is needed that uses reproducible sampling methods and examines decision support strategies that lead to quality decisions.

Administration of omega-3 fatty acids and Raloxifene to women at high risk of breast cancer: interim feasibility and biomarkers analysis from a clinical trial

“…10,11 Consequently, these agents have limited acceptability in healthy subjects including women at high risk of developing breast cancer. 12,13 Therefore, safer and more effective chemopreventive strategies need to be developed to have a significant impact on the development of breast cancer. Since breast cancer requires the coordinated activation of multiple cellular mechanisms, a multi-targeted approach is needed to prevent the development of mammary carcinogenesis.…”

Assessing and managing breast cancer risk: Clinicians' current practice and future needs

“…While screening does not reduce breast cancer risk, and remains unproven in high-risk populations, it may aid in early diagnosis and is recommended [8]. Appropriate uptake of these measures, especially medical prevention, remains low [9,10].…”

The clinical effectiveness and cost-effectiveness of genotyping for CYP2D6 for the management of women with breast cancer treated with tamoxifen: a systematic review.

“…There are some data that have reported test uptake for breast cancer chemoprevention. 133,134 Uptake rates range between 11.7% in populations with poor genetic counselling and 31% in populations informed by genetic counselling. N, number of copies of the allele; NS, not stated.…”