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. 2017 Jun;67(659):e414-e427.
doi: 10.3399/bjgp17X689377. Epub 2017 Feb 13.

Prescribing tamoxifen in primary care for the prevention of breast cancer: a national online survey of GPs' attitudes

Samuel G Smith  1 , Robbie Foy  2 , Jennifer A McGowan  3 , Lindsay C Kobayashi  4 , Andrea de Censi, Andrea DeCensi #  5 , Karen Brown  6 , Lucy Side  7 , Jack Cuzick  8
Affiliations

Prescribing tamoxifen in primary care for the prevention of breast cancer: a national online survey of GPs' attitudes

Samuel G Smith et al. Br J Gen Pract. 2017 Jun.

Erratum in

  • Corrections.
    [No authors listed] [No authors listed] Br J Gen Pract. 2018 Oct;68(675):468. doi: 10.3399/bjgp18X699029. Br J Gen Pract. 2018. PMID: 30262612 Free PMC article. No abstract available.

Abstract

Background: The cancer strategy for England (2015-2020) recommends GPs prescribe tamoxifen for breast cancer primary prevention among women at increased risk.

Aim: To investigate GPs' attitudes towards prescribing tamoxifen.

Design and setting: In an online survey, GPs in England, Northern Ireland, and Wales (n = 928) were randomised using a 2 × 2 between-subjects design to read one of four vignettes describing a healthy patient seeking a tamoxifen prescription.

Method: In the vignette, the hypothetical patient's breast cancer risk (moderate versus high) and the clinician initiating the prescription (GP prescriber versus secondary care clinician [SCC] prescriber) were manipulated in a 1:1:1:1 ratio. Outcomes were willingness to prescribe, comfort discussing harms and benefits, comfort managing the patient, factors affecting the prescribing decision, and awareness of tamoxifen and the National Institute for Health and Care Excellence (NICE) guideline CG164.

Results: Half (51.7%) of the GPs knew tamoxifen can reduce breast cancer risk, and one-quarter (24.1%) were aware of NICE guideline CG164. Responders asked to initiate prescribing (GP prescriber) were less willing to prescribe tamoxifen than those continuing a prescription initiated in secondary care (SCC prescriber) (68.9% versus 84.6%, P<0.001). The GP prescribers reported less comfort discussing tamoxifen (53.4% versus 62.5%, P = 0.01). GPs willing to prescribe were more likely to be aware of the NICE guideline (P = 0.039) and to have acknowledged the benefits of tamoxifen (P<0.001), and were less likely to have considered its off-licence status (P<0.001).

Conclusion: Initiating tamoxifen prescriptions for preventive therapy in secondary care before asking GPs to continue the patient's care may overcome some prescribing barriers.

Keywords: breast cancer; chemoprevention; general practice; preventive therapy; primary care; tamoxifen.

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Figures

Figure 1.
Figure 1.
GPs’ sources of information about tamoxifen (n = 243).
See this image and copyright information in PMC

References

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    1. Nelson HD, Zakher B, Cantor A, et al. Risk factors for breast cancer for women aged 40 to 49 years: a systematic review and meta-analysis. Ann Intern Med. 2012;156(9):635–648. - PMC - PubMed
    1. National Institute for Health and Care Excellence . Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer. CG164. London: ICE; 2013. https://www.nice.org.uk/guidance/cg164 (accessed 27 Jan 2017) - PubMed
    1. 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):1827–1834. - PMC - PubMed
    1. Cuzick J, Wickerham L, Powles T. Differing perspectives on breast cancer chemoprevention. JAMA Oncol. 2016;2(2):276–277. - PubMed

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