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Hereditary Cancer in Clinical Practice
Published in: Hereditary Cancer in Clinical Practice 1/2017

Open Access 01-12-2017 | Review

Motivators and barriers of tamoxifen use as risk-reducing medication amongst women at increased breast cancer risk: a systematic literature review

Authors: B. Meiser, W. K. T. Wong, M. Peate, C. Julian-Reynier, J. Kirk, G. Mitchell

Published in: Hereditary Cancer in Clinical Practice | Issue 1/2017

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Abstract

Background

Selective estrogen receptor modulators, such as tamoxifen, reduce breast cancer risk by up to 50% in women at increased risk for breast cancer. Despite tamoxifen’s well-established efficacy, many studies show that most women are not taking up tamoxifen. This systematic literature review aimed to identify the motivators and barriers to tamoxifen use ‘s amongst high-risk women.

Methods

Using MEDLINE, PsycINFO, and Embase plus reviewing reference lists of relevant articles published between 1995 and 2016, 31 studies (published in 35 articles) were identified, which addressed high-risk women’s decisions about risk-reducing medication to prevent breast cancer and were peer-reviewed primary clinical studies.

Results

A range of factors were identified as motivators of, and barriers to, tamoxifen uptake including: perceived risk, breast-cancer-related anxiety, health professional recommendation, perceived drug effectiveness, concerns about side-effects, knowledge and access to information about side-effects, beliefs about the role of risk-reducing medication, provision of a biomarker, preference for other forms of breast cancer risk reduction, previous treatment experience, concerns about randomization in clinical trial protocols and finally altruism.

Conclusions

Results indicate that the decision for high-risk women regarding tamoxifen use or non-use as a risk-reducing medication is not straightforward. Support of women making this decision is essential and needs to encompass the full range of factors, both informational and psychological.
Literature
1.
Donnelly LS, Evans DG, Wiseman J, Fox J, Greenhalgh R, Affen J, et al. Uptake of tamoxifen in consecutive premenopausal women under surveillance in a high-risk breast cancer clinic. Br J Cancer. 2014;110(7):1681–7.CrossRefPubMedPubMedCentral
2.
Metcalfe KA, Snyder C, Seidel J, Hanna D, Lynch HT, Narod S. The use of preventive measures among healthy women who carry a BRCA1 or BRCA2 mutation. Familial Cancer. 2005;4(2):97–103.CrossRefPubMed
3.
Cuzick J, Sestak I, Bonanni B, et al. Selective oestrogen receptor modulators in prevention of breast cancer: an updated meta-analysis of individual participant data. Lancet. 2013;381(9880):1827–34.CrossRefPubMedPubMedCentral
4.
Narod S. Tamoxifen chemoprevention—end of the road? Journal of the Amercican Medical Association Oncology. 2015;1(8):1033–4.
5.
Moyer V, U.S. Preventive Services Task Force. Medications to decrease the risk for breast cancer in women: recommendations from the U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159:698–708.PubMed
6.
Visvanathan K, Hurley P, Bantug E, Brown P, Col N, Cuzick J, et al. Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2013;31:2942–62.CrossRefPubMed
7.
Schwartz M, Isaacs C, Graves KD, Poggi E, Peshkin BN, Gell C, et al. Long-term outcomes of BRCA1/BRCA2 testing: risk reduction and surveillance. Cancer. 2012;118(2):510–7.CrossRefPubMed
8.
Heisey R, Pimlott N, Clemons M, Cummings S, Drummond N. Women’s views on chemoprevention of breast cancer: qualitative study. Can Fam Physician. 2006;52:625–332.
9.
Fagerlin A, Zikmund-Fisher BJ, Smith DM, Nair V, Derry HA, McClure JB, et al. Women's decisions regarding tamoxifen for breast cancer prevention: responses to a tailored decision aid. Breast Cancer Res Treat. 2010;119(3):613–20.CrossRefPubMedPubMedCentral
10.
Razzaboni E, Toss A, Cortesi L, Marchi I, Sebastiani F, De Matteis E, et al. Acceptability and adherence in a chemoprevention trial among women at increased risk for breast cancer attending the Modena familial breast and ovarian cancer center. Breast J. 2013;19(1):10–21.CrossRefPubMed
11.
Fallowfield L, Fleissig A, Edwards R, West A, Powles TJ, Howell A, et al. Tamoxifen for the prevention of breast cancer: psychosocial impact on women participating in two randomised controlled trials. J Clin Oncol. 2001;19(7):1885–92.CrossRefPubMed
12.
Melnikow J, Paterniti D, Azari R, Kuenneth C, Birch S, Kuppermann M, et al. Preferences of women evaluating risks of tamoxifen (POWER) study of preferences for tamoxifen for breast cancer risk reduction. Cancer. 2005;103(10):1996–2005.CrossRefPubMed
13.
Smith S, Sestak I, Forster A, Partridge A, Side L, Wolf M, et al. Factors affecting uptake and adherence to breast cancer chemoprevention: a systematic review and meta-analysis. Ann Oncol. 2016;27(4):575–90.CrossRefPubMed
14.
McKay A, Martin W, Latosinsky S. How should we inform women at higher risk of breast cancer about tamoxifen? An approach with a decision guide. Breast Cancer Res Treat. 2005;94(2):153–9.CrossRefPubMed
15.
Dillard A, Ubel P, Smith DM, Zikmund-Fisher BJ, Nair V, Derry HA, et al. The distinct role of comparative risk perceptions in a breast cancer prevention program. Ann Behav Med. 2011;42(2):262–8.CrossRefPubMedPubMedCentral
16.
Stacey D, DeGrasse C, Johnston L. Addressing the support needs of women at high risk for breast cancer: evidence-based care by advanced practice nurses. Oncol Nurs Forum. 2002;29(6):E77–84.CrossRefPubMed
17.
Moher D, Liberati A, Tetzlaff J, Altman D, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Medicine. 2009;6(7):e10000097.CrossRef
18.
Goldenberg V, Seewaldt V, Scott V, Bean G, Broadwater G, Fabian C, et al. Atypia in random Periareolar fine-needle aspiration affects the decision of women at high risk to take tamoxifen for breast cancer chemoprevention. Cancer Epidemiology Biomarkers and Prevention. 2007;16(5):1032–4.CrossRef
19.
Julian-Reynier C, Bouchard J, Evans DG, Eisinger FA, Foulkes WD, Kerr B, et al. Women's attitudes toward preventive strategies for hereditary breast or ovarian carcinoma differ from one country to another. Cancer. 2001;92(4):959–68.CrossRefPubMed
20.
Muir A, Meiser B, Tucker M, Andrews L, Tucker K, Friedlander M. The feasibility of women at high risk for breast cancer participating in chemoprevention trials. J Psychosoc Oncol. 2004;22(4):31–45.CrossRef
21.
Salant T, Ganschow P, Olopade O, Lauderdale D. “Why take it if you Don’t have anything?” Breast Cancer Risk Perceptions and Prevention Choices at a Public Hospital. Journal of General Internal Medicine. 2006;21:779–85.CrossRefPubMedPubMedCentral
22.
Underhill ML, Lally RM, Kiviniemi MT, Murekeyisoni C, Dickerson S. Living my family's story: identifying the lived experience in healthy women at risk for hereditary breast cancer. Cancer Nurs. 2012;35(6):493–504.CrossRefPubMedPubMedCentral
23.
Altschuler A, Somkin CP. Women’s decision making about whether or not to use breast cancer chemoprevention. Women Health. 2005;41(2):81–95.CrossRefPubMed
24.
Bober SL, Hoke LA, Duda RB, Regan MM, Tung NM. Decision-making about tamoxifen in women at high risk for breast cancer: clinical and psychological factors. J Clin Oncol. 2004;22(24):4951–7.CrossRefPubMed
25.
Julian-Reynier C, Mancini J, Mouret-Fourme E, Gauthier-Villars M, Bonadona V, Berthet P, et al. Cancer risk management strategies and perceptions of unaffected women 5 years after predictive genetic testing for BRCA1/2 mutations. Eur J Hum Genet. 2011;19(5):500–6.CrossRefPubMedPubMedCentral
26.
Meiser B, Butow P, Price M, Bennett B, Berry G, Tucker K. Attitudes to prophylactic surgery and chemoprevention in Australian women at increased risk for breast cancer. J Women’s Health. 2003;12(8):769–78.CrossRef
27.
Paterniti DA, Melnikow J, Nuovo J, Henderson S, DeGregorio M, Kuppermann M, et al. “I’m going to die of something anyway”: women's perceptions of tamoxifen for breast cancer risk reduction. Ethn Dis. 2005;15(3):365–72.PubMed
28.
Ropka ME, Keim J, Philbrick JT. Patient decisions about breast cancer chemoprevention: a systematic review and meta-analysis. J Clin Oncol. 2010;28(18):3090–5.CrossRefPubMedPubMedCentral
29.
Fagerlin A, Dillard AJ, Smith DM, Zikmund-fisher BJ, Pitsch R, McClure JB, et al. Women’s interest in taking tamoxifen and raloxifene for breast cancer prevention: response to a tailored decision aid. Breast Cancer Res Treat. 2011;127(3):681–8.CrossRefPubMedPubMedCentral
30.
Matloff ET, Moyer A, Shannon KM, Niendorf KB, Col NF. Healthy women with a family history of breast cancer: impact of a tailored genetic counseling intervention on risk perception, knowledge, and menopausal therapy decision making. J Women’s Health. 2006;15(7):843–56.CrossRef
31.
Taylor R, Taguchi K. Tamoxifen for breast cancer chemoprevention: low uptake by high-risk women. Annal of Family Medicine. 2005;3:242–7.CrossRef
32.
Dillard, A., L. Scherer, P.A. Ubel, D.M. Smith, B.J. Zikmund-Fisher, J.B. McClure, et al. Breast cancer anxiety's associations with responses to a chemoprevention decision aid. Social Science Medicine. 2013 77(0): p. 13–19.
33.
Gorin SSP, Wang C, Raich P, Bowen DJ, Hay J. Decision making in cancer primary prevention and chemoprevention. Ann Behav Med. 2006;32(3):179–87.CrossRefPubMed
34.
Tjia J, Micco E, Armstrong K. Interest in breast cancer chemoprevention among older women. Breast Cancer Res Treat. 2008;108(3):435–53.CrossRefPubMed
35.
Kinney A, Richards C, Vernon S, Vogel V. The effect of physician recommendation on enrollment in the breast cancer chemoprevention trial. Prev Med. 1998;27:713–9.CrossRefPubMed
36.
Kinney A, Vernon S, Frankowski R, Weber D, Bitsura J, Vogel V. Factors related to enrollment in the breast cancer prevention trial at a Comprehensive Cancer Center during the first year of recruitment. Cancer. 1995;76(1):46–56.CrossRef
37.
Kinney A, Vernon S, Shui W, Weber D, Schell M, Vogel V. Validation of a model predicting enrollment status in a chemoprevention trial for breast cancer. Cancer Epidemiol Biomarkers Prev. 1998;7:591–5.
38.
Port ER, Montgomery LL, Heerdt AS, Borgen PI. Patient reluctance toward tamoxifen use for breast cancer primary prevention. Ann Surg Oncol. 2001;8(7):580–5.CrossRefPubMed
39.
Cyrus-David M, Strom S. Chemoprevention of breast cancer with selective estrogen receptor modulators: views from broadly diverse focus groups of women with elevated risk for breast cancer. Psycho-Oncology. 2001;10(6):521–33.CrossRefPubMed
40.
Loehberg C, Jud S, Haeberle L, Heusinger K, Dilbat G, Hein A, et al. Breast cancer risk assessment in a mammography screening program and participation in the IBIS-II chemoprevention trial. Breast Cancer Research Treatment. 2010;121(1):101–10.CrossRefPubMed
41.
McKinnon W, Naud S, Ashikaga T, Colletti R, Wood M. Results of an intervention for individuals and families with BRCA mutations: A model for providing medical updates and psychosocial support following genetic testing. Journal of Genetic Counsselling. 2007;16(4):433–56.CrossRef
42.
Rondanina G, Puntoni M, Severi G, Varricchio C, Zunino A, Feroce I, et al. Psychological and clinical factors implicated in decision making about a trial of low-dose tamoxifen in hormone replacement therapy users. J Clin Oncol. 2008;26(9):1537–43.CrossRefPubMed
43.
Tchou J, Hou N, Rademaker A, Jordan V, Morrow M. Acceptance of tamoxifen chemoprevention by physicians and women at risk. Cancer. 2004;100:1800–6.CrossRefPubMed
44.
Domchek S, TM F, Singer C, Evans D, Lynch H, Isaacs C, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304(9):967–75.CrossRefPubMedPubMedCentral
45.
Maisonneuve A-S, Huiart L, Rabayrol L, Horsman D, Didelot R, Sobol H, et al. Acceptability of cancer chemoprevention trials: impact of the design. Int J Med Sci. 2008;5(5):244–7.CrossRefPubMedPubMedCentral
46.
Meiser B, Butow P, Friedlander M, Schnieden V, Gattas M, Kirk J, et al. Intention to undergo prophylactic mastectomy in women at increased risk of developing hereditary breast cancer. J Clin Oncol. 2000;18(11):2250–7.CrossRefPubMed
47.
Leventhal H. In: Johnston M, Wallace L, editors. Emotional and behavioural responses, in Stress and medical procedures. Oxford: Oxford Science; 1989. p. 25–57.
48.
Gooding H, Organista K, Burack J, Bowles Biesecker B. Genetic susceptibility testing from a stress and coping perspective. Soc Sci Med. 2006;62:1880–90.CrossRefPubMed
49.
Marteau, T., Weinmann J., Self-regulation and behavioural response to DNA risk information: Theoretical analysis and framework for future research. 2006(62): p. 1360–1368.
50.
Jones C, Smith H, Llewellyn C. Evaluating the effectiveness of health beliefs model interventions on improving adherence: a systematic review. Health Psychol Rev. 2014;8(3):253–69.CrossRefPubMed
51.
Gronwald J, Robidoux A, Kim-Sing C, Tung N, Lynch H, Foulkes W, et al. Duration of tamoxifen use and the risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat. 2014;146:421–7.CrossRefPubMedPubMedCentral
52.
Collins I, Bickerstaffe A, Ranaweera T, Maddumarachchi S, Keogh LA, Emery J, et al. iPrevent: a tailored, web-based, decision support tool for breast cancer risk assessment and management. Breast Cancer Res Treat. 2016;156:171–82.CrossRefPubMedPubMedCentral
53.
Cuzick J, Sestak I, Cawthorn S, Hamed H, Holli A, Howell A, et al. Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial. Lancet Oncol. 2015;16(1):67–75.CrossRefPubMedPubMedCentral
Metadata
Title
Motivators and barriers of tamoxifen use as risk-reducing medication amongst women at increased breast cancer risk: a systematic literature review
Authors
B. Meiser
W. K. T. Wong
M. Peate
C. Julian-Reynier
J. Kirk
G. Mitchell
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Hereditary Cancer in Clinical Practice / Issue 1/2017
Electronic ISSN: 1897-4287
DOI
https://doi.org/10.1186/s13053-017-0075-8

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