Most High-Risk Women Reject Tamoxifen Chemoprevention

NEW ORLEANS—The 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 effects—including endometrial cancer, thromboembolism, and menopause-like systems—as 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.