Women's preferences for selective estrogen reuptake modulators: an investigation using the time trade-off technique.

Angelique F Ralph,Kelly-Anne Phillips,Ian M Collins,Phyllis Butow,Kathy Tucker,Lesley Andrews,Nicole O’Reilly,Brittany Ager,Melanie L Bell

doi:10.1186/2193-1801-3-264

Abstract

PurposeSelective Estrogen Receptor Modulators (SERMs) reduce the risk of breast cancer for women at increased risk by 38%. However, uptake is extremely low and the reasons for this are not completely understood. The aims of this study were to utilize time trade-off methods to determine the degree of risk reduction required to make taking SERMs worthwhile to women, and the factors associated with requiring greater risk reduction to take SERMs.MethodsWomen at increased risk of breast cancer (N = 107) were recruited from two familial cancer clinics in Australia. Participants completed a questionnaire either online or in pen and paper format. Hierarchical multiple linear regression analysis was used to analyze the data.ResultsOverall, there was considerable heterogeneity in the degree of risk reduction required to make taking SERMs worthwhile. Women with higher perceived breast cancer risk and those with stronger intentions to undergo (or who had undergone) an oophorectomy required a smaller degree of risk reduction to consider taking SERMs worthwhile.ConclusionWomen at increased familial risk appear motivated to consider SERMs for prevention. A tailored approach to communicating about medical prevention is essential. Health professionals could usefully highlight the absolute (rather than relative) probability of side effects and take into account an individual’s perceived (rather than objective) risk of breast cancer.

Highlights

A strong family history of breast cancer and/or carrying a germline mutation in the BRCA1 or BRCA2 gene, substantially increases breast cancer risk (Antoniou et al.2003; Pharoah et al 1997)
Women with higher perceived breast cancer risk and those with stronger intentions to undergo an oophorectomy required a smaller degree of risk reduction to consider taking selective estrogen receptor modulators (SERMs) worthwhile
Analysis comparing de-identified data on non-responders with that of responders indicated that more women at moderate risk participated (53%) than did not participate (47%) compared to women at high risk (33% versus 67%) or those who were BRCA1 or BRCA2 positive (24% versus 76%)

Summary

Introduction

A strong family history of breast cancer and/or carrying a germline mutation in the BRCA1 or BRCA2 gene, substantially increases breast cancer risk (Antoniou et al.2003; Pharoah et al 1997). There is strong evidence that SERMs such as tamoxifen and raloxifene, taken daily for 5 years, reduce breast cancer risk by 38% (Cuzick et al 2013). Uptake of these agents is very low, even in women at high familialrisk (Phillips et al 2006; Savage 2007; Vogel 2010; Keogh et al 2009; Evans et al 2001; Collins et al 2013). Whilst it has been estimated that 15% of women in the United

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