A survey among breast cancer specialists on the low uptake of breast cancer preventive therapy with tamoxifen or raloxifene

Background

Despite the strong evidence of efficacy and FDA indication, breast cancer chemoprevention with tamoxifen or raloxifene has found so far little uptake in clinical practice. This survey aims to evaluate the knowledge, attitudes and beliefs of expert physicians regarding the reasons of this low uptake.

Methods

In late 2012 and early 2013 a self administered questionnaire was given during breast cancer meetings in Italy and Switzerland or submitted electronically to the breast cancer European School of Oncology alumni. The questionnaire included 4 personal questions (gender, age, country of work and specialty) and a 5-point (from very important to unimportant) 10-item Likert Scale with the following, here summarized, statements on the reasons of low uptake: 1. no demonstrated mortality effect, 2. Fear of side effects, 3. lack of reliable surrogate markers, 4. unclear who is the appropriate physician, 5. risk models are difficult, 6. lack of medical knowledge, 7. prevention of otherwise curable cancer, 8. drugs have poor commercial interest, 9. off-label in EU, 10. waiting results of Aromatase Inhibitors trials.

Results

Of the 246 surveys collected, 219 were filled in. In the 168 surveys with demographic information there were 88 female and 81 male, 110 European and 58 non European, 113 oncologist and 55 non-oncologist physicians. In the overall response on 219 physicians, the off-label use of drugs (17%), the lack of mortality data (15%), the lack of knowledge among physicians (13%), poor commercial interest in these drugs (12%) and the fear of side effects (11%) were the top five “very important” reasons for the low uptake. In subgroup analysis the top statement was: i) the off-label use for physicians ≥ 45 years (47%), ii) the lack of mortality data for those 

Conclusions

This survey, which is the first to assess the attitudes of experts physicians towards breast cancer chemoprevention, highlights the complexity of this field and, coupled with the known barriers among potentially eligible women, may help to identify strategies to increase chemoprevention uptake.

Clinical trial identification

Not applicable

Legal entity responsible for the study

E.O. Ospedali Galliera di Genova

Funding

N/A

Disclosure

All authors have declared no conflicts of interest.