Abstract
IntroductionUptake of preventive therapies for breast cancer is low. We examined whether women at increased risk of breast cancer can be categorized into groups with similar medication beliefs, and whether belief group membership was prospectively associated with uptake of preventive therapy. Patients and MethodsWomen (n = 732) attending an appointment to discuss breast cancer risk were approached; 408 (55.7%) completed the Beliefs About Medicines and the Perceived Sensitivity to Medicines questionnaires. Uptake of tamoxifen at 3 months was reported in 258 (63.2%). The optimal number of belief groups were identified using latent profile analysis. ResultsUptake of tamoxifen was 14.7% (38/258). One in 5 women (19.4%; 78/402) reported a strong need for tamoxifen. The model fit statistics supported a 2-group model. Both groups held weak beliefs about their need for tamoxifen for current and future health. Group 2 (38%; 154/406 of the sample) reported stronger concerns about tamoxifen and medicines in general, and stronger perceived sensitivity to the negative effects of medicines compared with group 1 (62%; 252/406). Women with low necessity and lower concerns (group 1) were more likely to initiate tamoxifen (18.3%; 33/180) than those with low necessity and higher concerns (group 2) (6.4%; 5/78). After adjusting for demographic and clinical factors, the odds ratio was 3.37 (95% confidence interval, 1.08-10.51; P = .036). ConclusionUptake of breast cancer preventive therapy was low. A subgroup of women reported low need for preventive therapy and strong medication concerns. These women were less likely to initiate tamoxifen. Medication beliefs are targets for supporting informed decision-making.
Highlights
Breast cancer is the most common cancer in women worldwide.[1]
The objectives of this study were to: (1) assess whether women at increased risk of breast cancer can be categorized into groups with similar medication beliefs; (2) determine whether sociodemographic and clinical variables are related to medication belief group membership and; (3) examine whether medication belief groups are associated with tamoxifen uptake
Clinical Practice Points The effectiveness of preventive therapy for breast cancer depends on adequate uptake, but initiation rates remain low
Summary
Breast cancer is the most common cancer in women worldwide.[1] Preventive therapy is a risk reduction approach for women at increased risk of breast cancer. In a meta-analysis of 9 randomized trials, women at increased risk of breast cancer had at least a 30% lower risk of the disease if they used selective estrogen receptor modulators.[2] The IBIS-I (International Breast Cancer Intervention Study) indicated the preventive effect of tamoxifen lasts for at least 20 years.[3] The effectiveness of preventive therapy depends on adequate uptake but initiation rates remain low.[4,5,6,7]. Understanding subgroup differences in medication beliefs can support the development of personalized interventions
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