title: Preferences of Women Evaluating Risks of Tamoxifen (POWER) study of preferences for tamoxifen for breast cancer risk reduction.
abstract: BACKGROUND
  The objective of this study was to understand the attitudes and preferences of risk-eligible women regarding use of tamoxifen for breast cancer risk reduction.
  
  
  METHODS
  A cross-sectional, mixed-methods interview study was conducted at a university medical center and at community sites. Participants were women who had an estimated 5-year breast cancer risk > or = 1.7% and no prior breast cancer. Interviews were conducted in English or Spanish. The interview included a 15-minute, standardized educational session on the potential benefits and harms of tamoxifen followed by close-ended and open-ended questions about participants' inclinations to take tamoxifen and factors important to their decision. A demographic questionnaire, a test on knowledge of potential benefits and harms of tamoxifen, and an interview evaluation were included.
  
  
  RESULTS
  Two hundred fifty-five women completed interviews. Their estimated mean 5-year breast cancer risk was 2.8%; and their mean self-perceived 5-year risk was 32.7%. After the educational intervention, 45 women (17.6%) were inclined to take tamoxifen. Very high risk women (> 3.5%) were no more inclined to take it than women with lower risk (1.7-3.5%). In a multivariable analysis, lower income, confidence in the effectiveness of tamoxifen, and concern about fractures were associated with being inclined to take it; concern about pulmonary embolism, dyspareunia, cataracts, and low self-perceived breast cancer risk were associated negatively with taking tamoxifen. Participants expressed concerns about adverse effects.
  
  
  CONCLUSIONS
  Less than 20% of women were interested in tamoxifen after education about potential benefits and harms, despite a very high self-perceived breast cancer risk. Candidate chemoprevention agents must have few potential adverse effects to achieve widespread acceptance.
authors.affiliation: Department of Family and Community Medicine, University of California-Davis, Sacramento, California 95817, USA. jamelnikow@ucdavis.edu
authors.forename: Joy
authors.initials: J
authors.lastname: Melnikow
authors.forename: Debora
authors.initials: D
authors.lastname: Paterniti
authors.forename: Rahman
authors.initials: R
authors.lastname: Azari
authors.forename: Christina
authors.initials: C
authors.lastname: Kuenneth
authors.forename: Stephen
authors.initials: S
authors.lastname: Birch
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
authors.forename: James
authors.initials: J
authors.lastname: Nuovo
authors.forename: Janet
authors.initials: J
authors.lastname: Keyzer
authors.forename: Stuart
authors.initials: S
authors.lastname: Henderson
mesh_terms: D000328:Adult; D000368:Aged; D016588:Anticarcinogenic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000517:prevention & control*; D002386:Cataract / Q000139:chemically induced; D018890:Chemoprevention; D003430:Cross-Sectional Studies; D003657:Decision Making; D004414:Dyspareunia / Q000139:chemically induced; D005260:Female; D050723:Fractures, Bone / Q000139:chemically induced; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007182:Income; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011655:Pulmonary Embolism / Q000139:chemically induced; D018570:Risk Assessment; D012307:Risk Factors; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D016588:Anticarcinogenic Agents; D013629:Tamoxifen