Most Women Not Willing To Take Medications To Prevent Breast Cancer

Sam Smith, PhD CPsychol Cancer Research UK Postdoctoral Fellow Centre for Cancer Prevention Queen Mary University of London Wolfson Institute of Preventive Medicine London

Sam Smith, PhD CPsychol

MedicalResearch.com Interview with:
Sam Smith, PhD CPsychol

Cancer Research UK Postdoctoral Fellow
Centre for Cancer Prevention
Queen Mary University of London
Wolfson Institute of Preventive Medicine
London

Medical Research: What is the background for this study? What are the main findings?

Dr. Smith:  Several trials have demonstrated that agents (e.g. tamoxifen) can be used to prevent breast cancer among women at increased risk. However, their effectiveness is dependent upon their appropriate use by this patient group. Several studies have suggested that uptake is low, and that women are not taking the medications for the full 5 year course. We attempted to synthesize the evidence investigating these topics, as well as identify the factors affecting these behaviours.

The main findings are that only 1 in 6 women (16.3%) were willing to start taking oral medications to prevent breast cancer.

Furthermore, uptake rates were lower in routine clinical practice (9%) compared with trial enrollment rates (25%), suggesting that there may be problems with implementing chemoprevention within routine clinical care. We noted that day to day adherence and persistence over a short period (e.g. 1 year) was adequate, but when looking at the longer term studies only 1 in 10 reported that >80% of women were still taking their medications at the 5 year end point. Women may not be experiencing the full preventive effect of these medications.

Medical Research: What should clinicians and patients take away from your report?

Dr. Smith: Clinicians should take away that good quality communication was one of the main factors affecting uptake and adherence. Women who reported receiving better quality information and who had a greater rapport with their provider were more willing to take chemoprevention. Clinicians in leadership positions should be aware that not all of their colleagues will be fully aware of the evidence supporting chemoprevention. This can lead to reluctance to engage patients with the topic and may be an explanation for why we see this difference in uptake between trial enrolment and clinical care. Ensuring adequate training is in place can help to rectify this problem.

Patients should take away from this that chemoprevention is not for everyone, and many women choose not to take it. But ensuring that this decision is informed in critical, and my concern is that this is not necessarily happening consistently. Patients should discuss the topic with their provider and seek out evidence-based information from a reputable source if they are interesting in taking chemoprevention.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Smith: I would like to see decision support tools being put in place to ensure women are adequately supported during this complicated decision-making process. I would also like to see interventions put in place to support those women who do decide to take chemoprevention, but are struggling to maintain their regimen. There were many reasons why women were unable to complete the course of their medication, and identifying these should be a priority.

Citation:

G. Smith, I. Sestak, A. Forster, A. Partridge, L. Side, M.S. Wolf, R. Horne,J. Wardle, and J. Cuzick

Factors affecting uptake and adherence to breast cancer chemoprevention: A systematic review and meta-analysis
Ann Oncol first published online December 8, 2015 doi:10.1093/annonc/mdv590

Sam Smith, PhD CPsychol (2015). Most Women Not Willing To Take Medications To Prevent Breast Cancer