Uptake of breast cancer chemoprevention in the United Kingdom: results from a multicentre prospective survey and qualitative interviews

Authors: Hackett J, Thorneloe R, Smith SG

Category: Lifestyles Behavior, Energy Balance & Chemoprevention, Behavioral Science & Health Communication
Conference Year: 2018

Abstract Body:
Breast cancer incidence is increasing worldwide. Family history of the disease accounts for up to 10% of all breast cancer cases. Selective Estrogen Receptor Modulators (SERMs) (e.g. tamoxifen) taken for five years reduce breast cancer risk by at least 30% in high risk groups. However, uptake in the UK is unknown and the factors affecting decision-making are not understood. We aimed to report uptake of tamoxifen overall and by socio-demographic group following its introduction into the UK National Health Service. We collected survey data from high risk healthy women attending 19 genetics centres in England. In total, 408 (55.7%) women provided data on participant characteristics and socio-demographics. At 3 months, 258 (63.2%) of respondents provided tamoxifen uptake data. Sixteen women participated in interviews about their decision-making. Quantitative data were analysed using multivariable logistic regression. Qualitative data were analysed thematically. Uptake of breast cancer chemoprevention was 14.7%. In a multivariable model, decision-making was unaffected by education, ethnicity, marital status, employment, neighbourhood deprivation, lifetime breast cancer risk, or health status (all p>0.05). Women who had children were more likely to report uptake of chemoprevention than those without children (17.6% vs. 3.8%, respectively). This was statistically significant in the multivariable model (OR=5.26; 95% CI 1.13, 24.49; p=0.035). Qualitative data supported these findings. Mother’s considered their children and broader family when making decisions about chemoprevention. However, male partners were rarely consulted, and there was a reliance on female relatives who had previously used SERMs for breast cancer treatment. Following the introduction of breast cancer chemoprevention in the UK, these data from a multi-centre nationwide study suggest uptake is low. Differences in uptake by socio-demographic group were not apparent, and therefore inequalities may not be created by offering chemoprevention in genetics clinics. Decision-making appears to be influenced by the social network, particularly with regard to children. Clinicians should consider the familial context when counselling patients considering chemoprevention.

Keywords: Chemoprevention; decision- making; tamoxifen; breast cancer