Breast Cancer Research and Treatment

, Volume 133, Issue 1, pp 357–366 | Cite as

Willingness to use tamoxifen to prevent breast cancer among diverse women

  • Celia Patricia Kaplan
  • Sue E. Kim
  • Sabrina T. Wong
  • George F. Sawaya
  • Judith M. E. Walsh
  • Eliseo J. Pérez-Stable
Epidemiology

Abstract

Use of chemoprevention to prevent development of breast cancer among high-risk women has been limited despite clinical evidence of its benefit. Our goals were to determine whether knowledge of the benefits and risks of tamoxifen affects a woman’s willingness to take it to prevent breast cancer, to define factors associated with willingness to take tamoxifen, and to evaluate race/ethnic differences. Women, ages 50–80, who identified as African American, Asian, Latina, or White, and who had at least one visit to a primary care physician in the previous 2 years, were recruited from ambulatory practices. After a screening telephone survey, women completed an in-person interview in their preferred language. Multivariate regression models were constructed to examine the associations of demographic characteristics, numeracy, breast cancer history, and health knowledge with willingness to take tamoxifen. Over 40% of the women reported they would likely take tamoxifen if determined to be at high risk, and 31% would be somewhat likely to do so. Asian women, those with no insurance, and those with less than high school education were significantly more likely to be willing to take tamoxifen. Higher scores on numeracy and on breast cancer knowledge were also associated with willingness to take tamoxifen. A higher tamoxifen knowledge score was inversely related to willingness to take the drug. Factors affecting women’s willingness to take breast cancer chemoprevention drugs vary and are not determined solely by knowledge of risk/benefit or risk perception.

Keywords

Tamoxifen Breast cancer prevention Chemoprevention therapy Numeracy Minority populations 

Notes

Acknowledgment

This study was supported by the Agency for Healthcare Research and Quality (5P01 HS10856) for an Excellence Center to Eliminate Ethnic/Racial Disparities (EXCEED) and by Grant P30-AG15272 under the Resource Centers for Minority Aging Research program by the National Institute on Aging, National Institutes of Health and by NIH/NCRR UCSF-CTSI Grant Number UL1 RR024131.

Conflict of interest

None of the authors have any conflict of interest.

References

  1. 1.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ (2007) Cancer statistics, 2007. CA Cancer J Clin 57(1):43–66PubMedCrossRefGoogle Scholar
  2. 2.
    Chlebowski RT (2002) Breast cancer risk reduction: strategies for women at increased risk. Annu Rev Med 53:519–540PubMedCrossRefGoogle Scholar
  3. 3.
    AHRQ (2007) The guide to clinical preventive services. Recommendations of the U.S. preventive services task force. The Agency for Healthcare Research and QualityGoogle Scholar
  4. 4.
    Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, Vogel V, Robidoux A, Dimitrov N, Atkins J et al (1998) Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 90(18):1371–1388PubMedCrossRefGoogle Scholar
  5. 5.
    Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN, Bevers TB, Fehrenbacher L, Pajon ER Jr, Wade JL 3rd et al (2006) Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP study of tamoxifen and raloxifene (STAR) P-2 trial. JAMA 295(23):2727–2741PubMedCrossRefGoogle Scholar
  6. 6.
    Bastian L, Lipkus I, Kuchibhatla M, Weng H, Halabi S, Ryan P, Skinner C, Rimer B (2001) Women’s interest in chemoprevention for breast cancer. Arch Intern Med 161:1639–1644PubMedCrossRefGoogle Scholar
  7. 7.
    Taylor R, Taguchi K (2005) Tamoxifen for breast cancer chemoprevention: low uptake by high-risk women after evaluation of a breast lump. Ann Fam Med 3(3):242–247PubMedCrossRefGoogle Scholar
  8. 8.
    Bober SL, Hoke LA, Duda RB, Regan MM, Tung NM (2004) Decision-making about tamoxifen in women at high risk for breast cancer: clinical and psychological factors. J Clin Oncol 22(24):4951–4957PubMedCrossRefGoogle Scholar
  9. 9.
    Melnikow J, Paterniti D, Azari R, Kuenneth C, Birch S, Kuppermann M, Nuovo J, Keyzer J, Henderson S (2005) Preferences of women evaluating risks of tamoxifen (POWER) study of preferences for tamoxifen for breast cancer risk reduction. Cancer 103(10):1996–2005PubMedCrossRefGoogle Scholar
  10. 10.
    Tchou J, Hou N, Rademaker A, Jordan VC, Morrow M (2004) Acceptance of tamoxifen chemoprevention by physicians and women at risk. Cancer 100(9):1800–1806PubMedCrossRefGoogle Scholar
  11. 11.
    Kaplan C, Haas J, Pérez-Stable EJ, Gregorich S, Somkin C, Des Jarlais G, Kerlikowske K (2006) Breast cancer risk reduction options: awareness, discussion, and use among women from four ethnic groups. Cancer Epidemiol Biomark Prev 15(1):162–166CrossRefGoogle Scholar
  12. 12.
    Kim S, Pérez-Stable EJ, Wong S, Gregorich S, Sawaya G, Walsh J, Kaplan C (2008) Association between cancer risk perception and screening behavior among diverse women. Arch Intern Med 168(7):728–734PubMedCrossRefGoogle Scholar
  13. 13.
    Fagerlin A, Zikmund-Fisher B, Smith DM, Vijayan N, Derry H, McClure J, Greene S, Stark A, Alford S, Lantz P et al (2010) Women’s decisions regarding tamoxifen for breast cancer prevention: responses to a tailored decision aid. Breast Cancer Res Treat 119:613–620PubMedCrossRefGoogle Scholar
  14. 14.
    Denberg TD, Wong S, Beattie A (2005) Women’s misconceptions about cancer screening: implications for informed decision-making. Patient Educ Couns 57(3):280–285PubMedCrossRefGoogle Scholar
  15. 15.
    Harris-Kojetin LD, Fowler FJ Jr, Brown JA, Schnaier JA, Sweeny SF (1999) The use of cognitive testing to develop and evaluate CAHPS 1.0 core survey items. Consumer assessment of health plans study. Med Care 37(3 Suppl):MS10–MS21PubMedCrossRefGoogle Scholar
  16. 16.
    Schwartz L, Woloshin S, Black W, Welch H (1997) The role of numeracy in understanding the benefit of screening mammography. Ann Intern Med 127(11):966–972PubMedGoogle Scholar
  17. 17.
    Wong S, Pérez-Stable EJ, Kim S, Gregorich S, Sawaya G, Walsh J, Washington A, Kaplan C (2012) Using visual displays to communicate risk of cancer to diverse women. Patient Educ Couns. doi:10.1016/j.pec.2011.11.014
  18. 18.
    Port ER, Montgomery LL, Heerdt AS, Borgen PI (2001) Patient reluctance toward tamoxifen use for breast cancer primary prevention. Ann Surg Oncol 8(7):580–585PubMedCrossRefGoogle Scholar
  19. 19.
    Haas J, Kaplan C, Des Jarlais G, Gildengoin V, Pérez-Stable EJ, Kerlikowske K (2005) Perceived risk of breast cancer among women at average and increased risk. J Womens Health (Larchmt) 14(9):845–851CrossRefGoogle Scholar
  20. 20.
    Wong ST, Chen W, Bottorff JL, Hislop TG (2008) Treatment decision making among Chinese women with DCIS. J Psychosoc Oncol 26(4):53–73PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Celia Patricia Kaplan
    • 1
    • 2
    • 3
  • Sue E. Kim
    • 4
  • Sabrina T. Wong
    • 5
  • George F. Sawaya
    • 2
    • 6
  • Judith M. E. Walsh
    • 1
    • 7
  • Eliseo J. Pérez-Stable
    • 1
    • 2
    • 3
  1. 1.Division of General Internal Medicine, Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Medical Effectiveness Research Center for Diverse PopulationsUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Helen Diller Family Comprehensive Cancer CenterUniversity of California San FranciscoSan FranciscoUSA
  4. 4.Health and Barriers to EmploymentManpower Demonstration Research Corporation (MDRC)OaklandUSA
  5. 5.Culture, Gender, and Health Unit, School of Nursing, Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverCanada
  6. 6.Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of California San FranciscoSan FranciscoUSA
  7. 7.Women’s Health Clinical Research CenterUniversity of California San FranciscoSan FranciscoUSA

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