"I'm going to die of something anyway": women's perceptions of tamoxifen for breast cancer risk reduction.
OBJECTIVE
To investigate how ethnically diverse women who are eligible for tamoxifen prophylaxis because of their breast cancer risk decide about tamoxifen use for risk reduction.


METHODS
A qualitative intervention pilot study used focus groups to discuss the use of tamoxifen and to identify the concerns of ethnically diverse women about the preventive use of this drug. Focus group discussion involved exploration of the benefits and risks of tamoxifen prophylaxis, presentation of a standardized educational intervention, and focused discussion on attitudes about tamoxifen for prevention. Prominent themes emerged from iterative review of focus group transcripts.


RESULTS
Fear of breast cancer was not prominent, and participants were less inclined to take tamoxifen as preventive therapy after receiving information. Decisions were based on participants' understandings of competing risks and benefits. Specifically, participants expressed limited willingness to take medication with potential serious side effects for risk reduction and were unwilling to discontinue hormone replacement therapy. Uneasiness about the reliability of scientific studies surfaced in the focus groups comprised of White and Latina women. African-American women described faith as important to prevention.


CONCLUSIONS
Women were wary of taking a drug for a disease they might not develop. Women felt they had options other than tamoxifen to reduce their risk of breast cancer, including early detection, diet, faith, and complementary and alternative therapies.
Paterniti
Debora A
DA
Center for Health Services Research in Primary Care, University of California, Davis, Sacramento, CA 95817, USA. dapaterniti@ucdavis.edu
Melnikow
Joy
J
Nuovo
Jim
J
Henderson
Stuart
S
DeGregorio
Michael
M
Kuppermann
Miriam
M
Nease
Robert
R
D000368:Aged; D016588:Anticarcinogenic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000517:prevention & control*; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010353:Patient Education as Topic; D010865:Pilot Projects; D013629:Tamoxifen / Q000627:therapeutic use*
D016588:Anticarcinogenic Agents; D013629:Tamoxifen