title: Awareness of preventive medication among women at high risk for breast cancer and their willingness to consider transdermal or oral tamoxifen: a focus group study.
abstract: BACKGROUND
  Despite demonstrated efficacy, acceptance of selective estrogen receptor modulators (SERMs), such as tamoxifen, for breast cancer risk reduction remains low. Delivering SERMs via local transdermal therapy (LTT) could significantly reduce systemic effects and therefore may increase acceptance. We aim to assess women's knowledge of breast cancer prevention medications and views on LTT of SERMs.
  
  
  METHODS
  Focus groups were conducted with healthy women identified through the comprehensive breast center of a large urban cancer institution. Group discussions covered risk perceptions, knowledge of and concerns about risk reducing medications. Participants reported their perceived risk for breast cancer (average, below/above average), preference for SERMs in a pill or gel form, risk factors, and prior physician recommendations regarding risk-reducing medicines. Participants' breast cancer risk was estimated using tools based on the Gail Model. Trained personnel examined all qualitative results systematically; risk perceptions and preferred method of medication delivery were tallied quantitatively.
  
  
  RESULTS
  Four focus groups (N = 32) were conducted. Most participants had at least a college degree (78.2 %) and were of European (50 %) or African ancestry (31 %). The majority (72 %) were at elevated risk for breast cancer; approximately half of these women perceived themselves to be at elevated risk. Few participants had prior knowledge of preventive medications. The women noted a number of concerns about LTT, including dosage, impact on day-to-day life, and side effects; nonetheless, over 90 % of the women stated they would prefer LTT to a pill.
  
  
  CONCLUSIONS
  Awareness of preventive medications was low even in a highly educated sample of high-risk women. If given a choice in the route of administration, most women preferred a gel to a pill, anticipating fewer side effects. Future work should focus on demonstrating equivalent efficacy and reduced toxicity of topical over oral medications and on raising awareness of chemopreventive options for breast cancer.
authors.affiliation: Department of Surgery, University of Illinois College of Medicine at Mt. Sinai Hospital, 1500 South Fairfield Avenue, Chicago, IL, 60608, USA. Lindsey.karavites@northwestern.edu.
authors.forename: Lindsey C
authors.initials: LC
authors.lastname: Karavites
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 4-420, Chicago, IL, 60611, USA. subhashini.allu@gmail.com.
authors.forename: Subhashini
authors.initials: S
authors.lastname: Allu
authors.affiliation: Department of Surgery, Northwestern University Feinberg School of Medicine, Prentice Women's Hospital, 250 East Superior Street, Suite 4-420, Chicago, IL, 60611, USA. skhan@nmh.org.
authors.forename: Seema A
authors.initials: SA
authors.lastname: Khan
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 North Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA. k-kaiser@northwestern.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Kaiser
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001364:Awareness; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D017144:Focus Groups; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors; D013629:Tamoxifen / Q000008:administration & dosage*; D016387:Women's Health
chemical_list: D013629:Tamoxifen