title: Uptake of tamoxifen in consecutive premenopausal women under surveillance in a high-risk breast cancer clinic.
abstract: BACKGROUND
  Randomised trials of tamoxifen versus placebo indicate that tamoxifen reduces breast cancer risk by approximately 33%, yet uptake is low. Approximately 10% of women in our clinic entered the IBIS-I prevention trial. We assess the uptake of tamoxifen in a consecutive series of premenopausal women not in a trial and explore the reasons for uptake through interviews.
  
  
  METHODS
  All eligible women between 33 and 46 years at ≥17% lifetime risk of breast cancer and undergoing annual mammography in our service were invited to take a 5-year course of tamoxifen. Reasons for accepting (n=15) or declining (n=15) were explored using semi-structured interviews.
  
  
  RESULTS
  Of 1279 eligible women, 136 (10.6%) decided to take tamoxifen. Women >40 years (74 out of 553 (13.4%)) and those at higher non-BRCA-associated risk were more likely to accept tamoxifen (129 out of 1109 (11.6%)). Interviews highlighted four themes surrounding decision making: perceived impact of side effects, the impact of others' experience on beliefs about tamoxifen, tamoxifen as a 'cancer drug', and daily reminder of cancer risk.
  
  
  CONCLUSIONS
  Tamoxifen uptake was similar to previously ascertained uptake in a randomised controlled trial (IBIS-I). Concerns were similar in women who did or did not accept tamoxifen. Decision making appeared to be embedded in the experience of significant others.
authors.affiliation: Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK.
authors.forename: L S
authors.initials: LS
authors.lastname: Donnelly
authors.affiliation: 1] Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK [2] Department of Genomic Medicine, MAHSC, St Mary's Hospital, Manchester M13 9WL, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Evans
authors.affiliation: Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK.
authors.forename: J
authors.initials: J
authors.lastname: Wiseman
authors.affiliation: Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK.
authors.forename: J
authors.initials: J
authors.lastname: Fox
authors.affiliation: Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK.
authors.forename: R
authors.initials: R
authors.lastname: Greenhalgh
authors.affiliation: Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK.
authors.forename: J
authors.initials: J
authors.lastname: Affen
authors.affiliation: Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW 2006, Australia.
authors.forename: I
authors.initials: I
authors.lastname: Juraskova
authors.affiliation: Manchester Academic Health Science Centre, University Hospital of South Manchester, University of Manchester, Manchester M23 9LT, UK.
authors.forename: P
authors.initials: P
authors.lastname: Stavrinos
authors.affiliation: Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK.
authors.forename: S
authors.initials: S
authors.lastname: Dawe
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK.
authors.forename: J
authors.initials: J
authors.lastname: Cuzick
authors.affiliation: 1] Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK [2] Department of Medical Oncology, Christie Hospital, Manchester M20 4BX, UK.
authors.forename: A
authors.initials: A
authors.lastname: Howell
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000517:prevention & control*; D002173:Cancer Care Facilities; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D017697:Premenopause / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013629:Tamoxifen / Q000008:administration & dosage*; D014930:Women / Q000523:psychology*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen