Research

Australian clinicians and chemoprevention for women at high familial risk for breast cancer

Louise A Keogh¹ , John L Hopper² , Doreen Rosenthal¹ and Kelly-Anne Phillips^2,3,4

¹  Key Centre for Women's Health in Society, School of Population Health, University of Melbourne, Australia

²  Centre for MEGA Epidemiology, School of Population Health, University of Melbourne, Australia

³  Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Australia

⁴  Department of Medicine, St Vincent's Hospital, The University of Melbourne, Australia

author email corresponding author email

Hereditary Cancer in Clinical Practice 2009, 7:9doi:10.1186/1897-4287-7-9

Published:	4 May 2009

Abstract

Objectives

Effective chemoprevention strategies exist for women at high risk for breast cancer, yet uptake is low. Physician recommendation is an important determinant of uptake, but little is known about clinicians' attitudes to chemoprevention.

Methods

Focus groups were conducted with clinicians at five Family Cancer Centers in three Australian states. Discussions were recorded, transcribed and analyzed thematically.

Results

Twenty three clinicians, including genetic counselors, clinical geneticists, medical oncologists, breast surgeons and gynaecologic oncologists, participated in six focus groups in 2007. The identified barriers to the discussion of the use of tamoxifen and raloxifene for chemoprevention pertained to issues of evidence (evidence for efficacy not strong enough, side-effects outweigh benefits, oophorectomy superior for mutation carriers), practice (drugs not approved for chemoprevention by regulatory authorities and not government subsidized, chemoprevention not endorsed in national guidelines and not many women ask about it), and perception (clinicians not knowledgeable about chemoprevention and women thought to be opposed to hormonal treatments).

Conclusion

The study demonstrated limited enthusiasm for discussing breast cancer chemoprevention as a management option for women at high familial risk. Several options for increasing the likelihood of clinicians discussing chemoprevention were identified; maintaining up to date national guidelines on management of these women and education of clinicians about the drugs themselves, the legality of "off-label" prescribing, and the actual costs of chemopreventive medications.