Patient Rather Than Physician-Related Barriers To Tamoxifen Uptake For Breast Cancer Prevention In High-Risk Women

Background: Tamoxifen use for 5 years confers 35% risk reduction in breast cancer at 15 years, although the evidence to support its use for BRCA1 or BRCA2 mutation carriers is less clear. Since 2014, it has been our policy to discuss and recommend endocrine prevention to every eligible individual who attends the risk management clinic (for gene carriers or women with a strong family history) at our institution. Aim: To assess the uptake of endocrine prevention in a high risk population when uniformly recommended and reasons for declining prevention. Methods: All patients attending risk management clinic between February 2014 until May, 2015 received both verbal and written evidence-based information on endocrine prevention and were registered prospectively. Endocrine prevention use and cessation was captured. Reasons for declining or ineligibility for tamoxifen use were recorded. Results: During the study period, 314 consultations were carried out on 248 women. They comprised 38 BRCA1 and 42 BRCA2 mutation carriers, 4 Peutz-Jegher syndrome patients, 155 women with strong family history, 9 with moderate family history. Their median age was 39.7 (range: 21-70 years). Despite routine policy, Tamoxifen prevention was routinely discussed, except where a patient required biopsy or was given biopsy results n=14 (7%). One patient had a new cancer diagnosis during this period. In 52 women, tamoxifen was not recommended for the following reasons: patients re-assessed as moderate risk (9), on other prevention trials (2), very young/old age (28), pregnant or breast-feeding (10) and previous mastectomy/cancer/DCIS (3). Of the remaining 182 eligible patients, 14 (8%) were on tamoxifen (median duration 12 months, range= 1-20 months), 8 (4%) had ceased tamoxifen due to side effects. Main reasons for declining were 25 (14%) were trying to conceive, 34 (19%) prefer prophylactic mastectomy, 15 (8%) were concerned regarding the side effects, 5 (3%) were currently suffering from menopause and 4 (2%) wished to await salpingo-oophorectomy. 66 (36%) indicated that they were ‘not interested’. Conclusions: Physician-reluctance is not the reason for poor uptake of endocrine prevention in a specialized risk management clinic. Contraindications are common, many women elect for alternative risk reducing strategies and despite supportive evidence, many women prefer to choose surveillance alone over medical prevention. Citation Format: Skandarajah AR, Thomas S, Chin-Lenn L, Mann B, Lindeman G. Patient rather than physician-related barriers to tamoxifen uptake for breast cancer prevention in high-risk women. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-02.