What Matters to Women When Making Decisions About Breast Cancer Chemoprevention?
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Despite the effectiveness of chemoprevention (tamoxifen and raloxifene) in preventing breast cancer among women at high risk for the disease, uptake is low. The objective of this study was to determine the tradeoff preferences for various attributes associated with chemoprevention among women not currently taking the drugs.
We used rating-based conjoint analysis to evaluate the relative importance of a number of attributes associated with chemoprevention, including risk of side effects, drug effectiveness, time needed to take the drugs, and availability of a blood test to see if the drugs were working in an Internet sample of women. We generated mean importance values and part-worth utilities for all attribute levels associated with taking chemoprevention. We then used multivariable linear regression to examine attribute importance scores controlling for participant age, race, Hispanic ethnicity, educational level, and a family history of breast cancer.
Overall interest in taking chemoprevention was low among the 1094 women included in the analytic sample, even for the scenario in which participants would receive the greatest benefit and fewest risks associated with taking the drugs. Time needed to take the pill for it to work and 5-year risk of breast cancer were the most important attributes driving tradeoff preferences between the chemoprevention scenarios.
Interest in taking chemoprevention among this sample of women at average risk was low. Addressing women’s concerns about the time needed to take chemoprevention for it to work may help clinicians improve uptake of the drugs among those likely to benefit.
Angela Fagerlin, Holly Witteman, Christine Holmberg, and Sarah Hawley conceptualized and designed the study, including the online rating-based conjoint exercise. Kathryn Martinez and Holly Witteman conducted data analysis. All authors assisted in interpreting the results. The complete first draft of the paper was written by Kathryn Martinez, with assistance from Angela Fagerlin and Sarah Hawley. All authors commented on the first complete draft as well as subsequent versions. Kathryn Martinez acts as guarantor for the paper.
Compliance with Ethical Standards
This study was funded by the National Institutes for Health (R01 CA87595 and P50 CA101451). Dr. Martinez was supported by a postdoctoral fellowship from the US Department of Veterans Affairs.
Conflicts of Interest
Kathryn Martinez, Angela Fagerlin, Holly Witteman, Christine Holmberg, and Sarah Hawley have no conflicts of interest to disclose.
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