"I'm going to die of something anyway": women's perceptions of tamoxifen for breast cancer risk reduction.
ABSTRACT To investigate how ethnically diverse women who are eligible for tamoxifen prophylaxis because of their breast cancer risk decide about tamoxifen use for risk reduction.
A qualitative intervention pilot study used focus groups to discuss the use of tamoxifen and to identify the concerns of ethnically diverse women about the preventive use of this drug. Focus group discussion involved exploration of the benefits and risks of tamoxifen prophylaxis, presentation of a standardized educational intervention, and focused discussion on attitudes about tamoxifen for prevention. Prominent themes emerged from iterative review of focus group transcripts.
Fear of breast cancer was not prominent, and participants were less inclined to take tamoxifen as preventive therapy after receiving information. Decisions were based on participants' understandings of competing risks and benefits. Specifically, participants expressed limited willingness to take medication with potential serious side effects for risk reduction and were unwilling to discontinue hormone replacement therapy. Uneasiness about the reliability of scientific studies surfaced in the focus groups comprised of White and Latina women. African-American women described faith as important to prevention.
Women were wary of taking a drug for a disease they might not develop. Women felt they had options other than tamoxifen to reduce their risk of breast cancer, including early detection, diet, faith, and complementary and alternative therapies.
- SourceAvailable from: Norman F Boyd
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- "Adverse effects in the NSABP-P1 trial included endometrial cancer in w1 of 91 women and veno-thrombotic events (deep venous thrombosis and pulmonary embolism) in w1 per 217. Analyzed in this way, the benefit to risk equation for the majority of women is not sufficient for them to choose tamoxifen for prevention (Paterniti et al. 2005). Three studies indicated that only 5, 18, and 51% of eligible women choose the tamoxifen prevention strategy (Port et al. 2001, Bober et al. 2004, Melnikow et al. 2005). "
ABSTRACT: The majority of candidates for breast cancer prevention have not accepted tamoxifen because of the perception of an unfavorable risk/benefit ratio and the acceptance of raloxifene remains to be determined. One means of improving this ratio is to identify women at very high risk of breast cancer. Family history, age, atypia in a benign biopsy, and reproductive factors are the main parameters currently used to determine risk. The most powerful risk factor, mammographic density, is not presently employed routinely. Other potentially important factors are plasma estrogen and androgen levels, bone density, weight gain, age of menopause, and fracture history, which are also not currently used in a comprehensive risk prediction model because of lack of prospective validation. The Breast Cancer Prevention Collaborative Group (BCPCG) met to critically examine and prioritize risk factors that might be selected for further testing by multivariate analysis using existing clinical material. The BCPCG reached a consensus that quantitative breast density, state of the art plasma estrogen and androgen measurements, history of fracture and height loss, BMI, and waist-hip ratio had sufficient priority for further testing. As a practical approach, these parameters could be added to the existing Tyrer-Cuzick model which encompasses factors included in both the Claus and Gail models. The BCPCG analyzed potentially available clinical material from previous prospective studies and determined that a large case/control study to evaluate these new factors might be feasible at this time.Endocrine Related Cancer 07/2007; 14(2):169-87. DOI:10.1677/ERC-06-0045 · 4.91 Impact Factor
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ABSTRACT: Despite the results of prospective randomized placebo controlled studies, endorsement from various professional societies, and approval by the FDA, the chemoprevention of breast cancer is limited. This is attributable to the perceived risks of complications with tamoxifen. Individualized risk-benefit calculation regarding the use of tamoxifen is burdensome for practical clinical use. We propose a Chemoprevention Indication Score (CIS) that is easy to compute and reliable to identify women suitable for chemoprevention.Breast (Edinburgh, Scotland) 09/2009; 18(5):289-93. DOI:10.1016/j.breast.2009.08.001 · 2.58 Impact Factor
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ABSTRACT: Tamoxifen can reduce the risk of developing invasive estrogen receptor-positive breast cancer by 49%, but it is unknown how many women in the United States are taking tamoxifen for primary prevention of breast cancer. Data from the years 2000 and 2005 National Health Interview Surveys were analyzed to estimate the prevalence of tamoxifen use among U.S. women for primary chemoprevention of breast cancer. In 2000, approximately 0.2% of U.S. women ages 40 to 79 years without a personal history of breast cancer took tamoxifen for chemoprevention (95% confidence interval, 0.13-0.31). In 2005, the prevalence was approximately 0.08% (95% confidence interval, 0.03-0.17). The prevalence of tamoxifen use for primary prevention of breast cancer was very low in the years 2000 and 2005. Possible explanations for the low uptake are explored.Cancer Epidemiology Biomarkers & Prevention 02/2010; 19(2):443-6. DOI:10.1158/1055-9965.EPI-09-0930 · 4.32 Impact Factor