title: Patient and medical barriers preclude uptake of tamoxifen preventative therapy in women with a strong family history.
abstract: OBJECTIVE
  To assess the eligibility, uptake and impediments to tamoxifen use in high-risk women attending a risk management clinic due to family history.
  
  
  METHODS
  All patients with a germline mutation in a cancer predisposing gene or at high genetic risk (based on family history) attending a Breast and Ovarian cancer risk management clinic from February 2014 to May 2015 received both verbal and written evidence-based information on preventive therapy and were recommended to consider endocrine prevention if not contraindicated. Endocrine therapy initiation, use and cessation were captured. Patient eligibility was analysed and reasons for declining, ceasing or contraindications for medication use were recorded.
  
  
  RESULTS
  During the study period, 237 women were seen over 305 consultations for breast surveillance and preventative therapy discussion. They comprised 38 BRCA1 and 42 BRCA2 mutation carriers, 4 with Peutz-Jegher syndrome, 153 with a strong family history. Their median age was 39.4 years. Endocrine preventative was considered and discussed with all but 19 women. Of the remaining 218, 34 chose bilateral prophylactic mastectomy, while endocrine preventative was not recommended in 50 women due to contraindications and 25 women declined treatment due to their intention to fall pregnant. In 118 patients who remained eligible, 18.6% (22) tried prevention and 9.4% (14) remained on therapy.
  
  
  CONCLUSIONS
  Physician-reluctance is not a dominant reason for poor uptake of endocrine prevention even by high-risk premenopausal women in a specialised risk management clinic. Many women are not eligible, and most elect for alternative options.
authors.affiliation: Breast Tumor Stream, Victorian Comprehensive Cancer Centre, Australia; Department of Surgery, The University of Melbourne, Royal Melbourne Hospital, Australia; Familial Cancer Centre, The Royal Melbourne Hospital, Peter MacCallum Cancer Centre, Australia. Electronic address: anita.skandarajah@mh.org.au.
authors.forename: Anita R
authors.initials: AR
authors.lastname: Skandarajah
authors.affiliation: Breast Tumor Stream, Victorian Comprehensive Cancer Centre, Australia; Familial Cancer Centre, The Royal Melbourne Hospital, Peter MacCallum Cancer Centre, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Breast Tumor Stream, Victorian Comprehensive Cancer Centre, Australia; Familial Cancer Centre, The Royal Melbourne Hospital, Peter MacCallum Cancer Centre, Australia; Stem Cells and Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Australia.
authors.forename: Kylie
authors.initials: K
authors.lastname: Shackleton
authors.affiliation: Breast Tumor Stream, Victorian Comprehensive Cancer Centre, Australia; Familial Cancer Centre, The Royal Melbourne Hospital, Peter MacCallum Cancer Centre, Australia.
authors.forename: Laura
authors.initials: L
authors.lastname: Chin-Lenn
authors.affiliation: Breast Tumor Stream, Victorian Comprehensive Cancer Centre, Australia; Familial Cancer Centre, The Royal Melbourne Hospital, Peter MacCallum Cancer Centre, Australia; Stem Cells and Cancer Division, The Walter and Eliza Hall Institute of Medical Research, Australia; Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Australia.
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Lindeman
authors.affiliation: Breast Tumor Stream, Victorian Comprehensive Cancer Centre, Australia; Department of Surgery, The University of Melbourne, Royal Melbourne Hospital, Australia; Familial Cancer Centre, The Royal Melbourne Hospital, Peter MacCallum Cancer Centre, Australia.
authors.forename: G Bruce
authors.initials: GB
authors.lastname: Mann
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001315:Australia; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology; D000075202:Contraindications; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease / Q000523:psychology*; D006801:Humans; D010349:Patient Compliance; D010580:Peutz-Jeghers Syndrome / Q000150:complications; D011247:Pregnancy; D000072036:Prophylactic Mastectomy / Q000523:psychology / Q000706:statistics & numerical data; D012307:Risk Factors; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen
keywords: Endocrine preventative therapies; Familial breast cancer; Risk assessment; Risk management