NEW ORLEANSThe vast majority of patients offered tamoxifen
(Nolvadex) for primary chemoprevention of breast cancer decline it,
even after exposure to an educational intervention program,
investigators from Memorial Sloan-Kettering Cancer Center reported at
the Society of Surgical Oncology (SSO) Cancer Symposium.
The prospective study included 43 women (mean age, 51) identified
through the clinics of four attending surgeons. All were considered
to be at high risk for breast cancer and candidates for primary
prevention with tamoxifen on the basis of history of lobular
carcinoma in situ or ductal carcinoma in situ, BRCA-1-positivity, or
Gail risk level of 1.7% over the next 5 years.
Subjects completed a baseline survey of knowledge and attitudes
toward tamoxifen. This was followed by education about actual risks
and benefits by means of literature and educational sessions.
Subsequent knowledge and attitudes were then evaluated.
Only 5% Accepted Treatment
Among these 43 high-risk women, only 5% accepted treatment with
tamoxifen; 35% elected not to use the agent; and 60% were undecided
at the end of the study. The undecided subjects are still not taking
tamoxifen at this time, Elisa Port, MD, reported at a poster session
during the meeting.
While women in the study overestimated their actual risk of
developing breast cancer, no woman changed her mind after the
educational effort. The subjects cited possible side
effectsincluding endometrial cancer, thromboembolism, and menopause-like
systemsas their greatest concerns.
Kirby I. Bland, MD, professor of surgery, University of Alabama at
Birmingham, noted that the study suggests reason for concern.
The behavioral scientists need to get involved in this kind of
interaction with patients, he said.