Prescription of Tamoxifen for Breast Cancer Prevention by Primary Care Physicians

Armstrong, Katrina; Quistberg, D. Alex; Micco, Ellyn; Domchek, Susan M.; Guerra, Carmen E.

doi:10.1001/archinte.166.20.2260

Cited by 67 publications

(63 citation statements)

References 27 publications

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“…Use of cancer chemopreventive agents is difficult to measure as these drugs all have other indications and the indications for use are not routinely recorded in drug databases. Several studies of tamoxifen and raloxifene use for breast cancer chemoprevention show that neither drug is being widely used by physicians or women at increased risk for breast cancer (19)(20)(21)(22)(23)(24)(25). Although aspirin is commonly used for cardiovascular disease prevention (26), its use for colorectal cancer prevention is also not known.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Use of Finasteride for the Prevention of Prostate Cancer

Hamilton

Kahwati

Kinsinger

2010

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: The knowledge about and use of chemopreventive agents for prostate cancer by physicians has not been described. The Prostate Cancer Prevention Trial (PCPT) showed that finasteride was effective in reducing the incidence of prostate cancer. We examined the influence of the PCPT on finasteride prescribing within the Veterans Health Administration (VHA).Methods: We assessed trends on monthly new and total prescriptions for finasteride filled within the VHA from January 2000 to December 2005. Additionally, all VHA urologists and a random sample of VHA primary care physicians (PCP) were surveyed about their use of finasteride.Results: The number of men starting finasteride grew over the study period. Publication of the PCPT was not significantly associated with any change in this pattern (P = 0.45). Fifty-seven percent of urologists and 40% of PCPs endorsed prescribing finasteride more frequently in 2006 than 5 years prior. However, among those who reported changing prescribing patterns, fewer than 2% reported being influenced by the PCPT. Sixty-four percent of urologists and 80% of PCPs never prescribe finasteride for prostate cancer chemoprevention; 55% of urologists cited concerns of inducing high-grade tumors, whereas 52% of PCPs did not know it could be used for chemoprevention.Conclusions: The number of men starting finasteride in the VHA increased over time, but the change did not seem to be due to increased use of finasteride for chemoprevention. Publication of the PCPT seemed to have little influence over the study period.Impact: Physicians may not readily accept the use of chemopreventive agents for prostate cancer.

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Section: Discussionmentioning

confidence: 99%

Knowledge and Use of Finasteride for the Prevention of Prostate Cancer

Hamilton

Kahwati

Kinsinger

2010

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Twelve studies described how women or physicians make decisions to use medications to reduce risk for primary breast cancer (Appendix Table 2, available at www .annals.org) (65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76). In an interview-based, cross-sectional study after an educational session about indications and adverse effects of tamoxifen, women indicated that breast cancer (69%), pulmonary embolism (67%), endometrial cancer (63%), and deep venous thrombosis (58%) were "very important" in making their decisions about use (69).…”

Section: Surveys Of Medication Decisions and Concordancementioning

confidence: 99%

“…Of 350 physicians responding to a mailed survey, 27% had prescribed tamoxifen for breast cancer risk reduction within the previous 12 months (65). Prescribers were more likely than nonprescribers to have a family member with breast cancer (20% vs. 9%) and believed that the benefits of tamoxifen outweigh the risks (63% vs. 39%), colleagues are prescribing it (33% vs. 17%), it is easy to determine who is eligible (28% vs. 11%), and many female patients ask for information about it (15% vs. 5%).…”

Section: Surveys Of Medication Decisions and Concordancementioning

confidence: 99%

Use of Medications to Reduce Risk for Primary Breast Cancer: A Systematic Review for the U.S. Preventive Services Task Force

Nelson¹,

Smith²,

Griffin³

et al. 2013

Ann Intern Med

161

138

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Background: Medications to reduce risk for primary breast cancer are recommended for women at increased risk; however, use is low. Purpose:To update evidence about the effectiveness and adverse effects of medications to reduce breast cancer risk, patient use of such medications, and methods for identifying women at increased risk for breast cancer.Data Sources: MEDLINE and Cochrane databases (through 5 December 2012), Scopus, Web of Science, clinical trial registries, and reference lists.Study Selection: English-language randomized trials of medication effectiveness and adverse effects, observational studies of adverse effects and patient use, and diagnostic accuracy studies of risk assessment. Data Extraction:Investigators independently extracted data on participants, study design, analysis, follow-up, and results, and a second investigator confirmed key data. Investigators independently dual-rated study quality and applicability using established criteria.Data Synthesis: Seven good-and fair-quality trials indicated that tamoxifen and raloxifene reduced incidence of invasive breast cancer by 7 to 9 cases in 1000 women over 5 years compared with placebo. New results from STAR (Study of Tamoxifen and Raloxifene) showed that tamoxifen reduced breast cancer incidence more than raloxifene by 5 cases in 1000 women. Neither reduced breast cancer-specific or all-cause mortality rates. Both reduced the incidence of fractures, but tamoxifen increased the incidence of thromboembolic events more than raloxifene by 4 cases in 1000 women. Tamoxifen increased the incidence of endometrial cancer and cataracts compared with placebo and raloxifene. Trials provided limited and heterogeneous data on medication adherence and persistence. Many women do not take tamoxifen because of associated harms. Thirteen risk-stratification models were modest predictors of breast cancer.Limitation: Data on mortality and adherence measures and for women who are nonwhite, are premenopausal, or have comorbid conditions were lacking. Conclusion:Medications reduced the incidence of invasive breast cancer and fractures and increased the incidence of thromboembolic events. Tamoxifen was more effective than raloxifene but also increased the incidence of endometrial cancer and cataracts. Use is limited by adverse effects and inaccurate methods to identify candidates. Primary Funding Source: Agency for Healthcare Research and Quality.Ann Intern Med. 2013;158:604-614. www.annals.org For author affiliations, see end of text. In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended that clinicians discuss the potential benefits and harms of tamoxifen and raloxifene for reducing risk for primary breast cancer with women at high risk for breast cancer and low risk for adverse effects (1, 2). The USPSTF also recommended against routine use in women at low or average risk for breast cancer.Clinical trials demonstrate the efficacy of several medications to reduce the risk for invasive breast cancer in women without preexisting cancer (3-8), but onl...

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“…Primary care clinicians have generally been unenthusiastic about tamoxifen for chemoprevention given its original use by oncologists in breast cancer treatment, combined with concerns about serious adverse events. 61,62 As a result, many women who were at increased risk of developing breast cancer were not considered to be candidates for tamoxifen chemoprevention therapy and were not offered risk-reduction therapy.…”

Section: Use Of Serms In Clinical Practicementioning

confidence: 99%

Opportunities and Strategies for Breast Cancer Prevention Through Risk Reduction

Mahoney

Bevers

Linos

et al. 2008

CA: A Cancer Journal for Clinicians

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Due to the high incidence of breast cancer among US females, risk-reduction strategies are essential. Before considering approaches to breast cancer risk reduction, it is important for clinicians to complete individualized qualitative and quantitative assessments of risk for their patients in order to inform physicians' clinical decision making and management and to engage patients collaboratively in a thorough discussion of risks and benefits. This review will summarize information on potential pharmacologic, nutritional, surgical, and behavioral approaches to reducing breast cancer risk.While there is no clear evidence that specific dietary components can effectively reduce breast cancer risk, weight gain and obesity in adulthood are risk factors for the development of postmenopausal breast cancer. Alcohol consumption, even at moderate levels, increases breast cancer risk, although some of the detrimental effects may be reduced by sufficient folate intake. Women at increased risk of breast cancer can opt to reduce their breast cancer risk through the use of tamoxifen or raloxifene; other chemopreventive agents remain under investigation. Surgical approaches to risk reductions are restricted to those patients with a substantially increased risk of developing breast cancer. Patients should be encouraged to maintain a healthy lifestyle for their overall well-being and to remain up to date with recommendations for screening and surveillance. (CA Cancer

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Prescription of Tamoxifen for Breast Cancer Prevention by Primary Care Physicians

Cited by 67 publications

References 27 publications

Knowledge and Use of Finasteride for the Prevention of Prostate Cancer

Knowledge and Use of Finasteride for the Prevention of Prostate Cancer

Use of Medications to Reduce Risk for Primary Breast Cancer: A Systematic Review for the U.S. Preventive Services Task Force

Opportunities and Strategies for Breast Cancer Prevention Through Risk Reduction

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