Uptake of breast cancer preventive therapy in the UK: results from a multicentre prospective survey and qualitative interviews

Abstract

PurposeUptake of preventive therapy for women at increased breast cancer risk in England is unknown following the introduction of UK clinical guidelines in 2013. Preventive therapy could create socioeconomic inequalities in cancer incidence if it is more readily accepted by particular socio-demographic groups. In this multicentre study, we investigated uptake of tamoxifen and evaluated socio-demographic and clinical factors associated with initiation. We explored women’s experiences of treatment decision-making using qualitative interview data.MethodsBetween September 2015 and December 2016, women (n = 732) attending an appointment at one of 20 centres in England to discuss breast cancer risk were approached to complete a survey containing socio-demographic details and nulliparity. Of the baseline survey respondents (n = 408/732, 55.7% response rate), self-reported uptake of tamoxifen at 3-month follow-up was reported in 258 (63.2%). Sixteen women participated in semi-structured interviews.ResultsOne in seven (38/258 = 14.7%) women initiated tamoxifen. Women who had children were more likely to report use of tamoxifen than those without children (OR = 5.26; 95%CI: 1.13–24.49, p = 0.035). Interview data suggested that women weigh up risks and benefits of tamoxifen within the context of familial commitments, with exposure to significant other’s beliefs and experiences of cancer and medication a basis for their decision.ConclusionsUptake of tamoxifen is low in clinical practice. There were no socio-demographic differences in uptake, suggesting that the introduction of breast cancer preventive therapy is unlikely to create socioeconomic inequalities in cancer incidence. Women’s decision-making was influenced by familial priorities, particularly having children.Electronic supplementary materialThe online version of this article (10.1007/s10549-018-4775-1) contains supplementary material, which is available to authorized users.

The accuracy of breast cancer risk self-assessment does not correlate with knowledge about breast cancer and knowledge and attitudes towards primary chemoprevention

“…Women with a 5-year BC risk of at least 1.67% or a lifetime risk of 20% or greater, based upon the Gail model ( Gail et al, 1989 , Costantino et al, 1999 ) are defined as high-risk women for developing BC and may benefit from chemoprevention ( Reimers et al, 2015 , Owens et al, 2019 ). However, uptake and adherence to the BC chemoprevention is estimated to be extremely low and according to some studies prevalence of the earliest chemopreventive agent, tamoxifen, in high-risk women is less than 5% ( Ropka et al, 2010 , Hackett et al, 2018 ). Numerous barriers to the use of chemopreventive drugs have been identified to date, such as lack of physician knowledge about SERMs and AIs use, physician and patient concerns about medication side effects and poor assessment of patients' own cancer risk ( Ropka et al, 2010 , Kartal et al, 2014 , Park et al, 2009 ).…”

“…Numerous barriers to the use of chemopreventive drugs have been identified to date, such as lack of physician knowledge about SERMs and AIs use, physician and patient concerns about medication side effects and poor assessment of patients' own cancer risk ( Ropka et al, 2010 , Kartal et al, 2014 , Park et al, 2009 ). A limited number of studies have examined the sociodemographic and clinical characteristics associated with uptake of chemopreventive therapy among high-risk women ( Reimers et al, 2015 , Hackett et al, 2018 ). Studies reported poor awareness and knowledge about BC in general population ( Islami et al, 2017 , Peltzer and Pengpid, 2014 , Ryan et al, 2015 ).…”

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

“…It is important to determine whether preventive therapies can create or exacerbate existing inequalities in breast cancer outcomes 17 . We have previously shown within this cohort that there are no sociodemographic differences in tamoxifen uptake 6 . In this study, medication belief group membership was associated with key indicators of SES, which might help identify those who would most benefit from additional decision-making support.…”

“…In total, 732 women were invited to complete a survey; 408 women (55.7%) returned the baseline survey (Table 1) and 258 (63.2%) women provided uptake data at least 3 months after their appointment (see Supplemental Figure 1 in the online version). Demographic and clinical differences between responders and nonresponders and between those who did and did not provide 3-month data are published elsewhere 6 . There were no differences between responders and nonresponders with regard to clinical risk, socioeconomic status (SES), or age group.…”

“…The IBIS-I (International Breast Cancer Intervention Study) indicated the preventive effect of tamoxifen lasts for at least 20 years 3 . The effectiveness of preventive therapy depends on adequate uptake but initiation rates remain low 4, 5, 6, 7…”