Chemoprevention for breast cancer: A survey of the views of Australian women and clinicians

Background: Chemoprevention for women at elevated risk of breast cancer is endorsed by international guidelines. This study examined the uptake of chemoprevention by Australian women at increased risk and aimed to identify modifiable barriers and facilitators for both patients and clinicians. Material and Methods: 1,113 participants enrolled in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer Follow-Up Study (kConFab FUS) and at ≥16% lifetime risk of BC (≥1.5 times the average population risk) were mailed a 68-item survey. 130 currently practising breast surgeons and 394 family doctors (FDs) who reportedly provided care for kConFab-FUS participants were sent a 49-item survey. Surveys were developed based on the theoretical domains framework. Results: 725 participants (65%) and 221 (42%) clinicians responded (147 (37%) FDs, 74 (57%) breast surgeons). The median age of participants was 55 years. Most (84%) were at moderately increased risk (<3 times population risk). Ten women (1.4%) had taken chemoprevention. Possible side effects, lack of information and preferring the adoption of a healthy lifestyle alone were the three strongest barriers. The 20-year reduction in BC risk with tamoxifen was the most important facilitator, followed by desire to stay healthy for their family and having an abnormal breast biopsy. Most patients preferred to get information from a cancer genetics centre (CGC) (38%) followed by their FD (33%). Most surgeons knew about chemoprevention (97%), but 35% of FDs did not; 7% and 74%, respectively, were not confident in providing chemoprevention information. The majority of FDs (75%) and breast surgeons (89%) thought discussing chemoprevention should be part of their role. For FDs the strongest barriers were insufficient knowledge and lack of confidence. For breast surgeons, the strongest barriers were medication side-effects and lack of consultation time. Clear guidelines and strong family history were facilitators for both clinician groups. FDs identified that availability of better tools to select suitable patients would be a strong facilitator. Conclusions: Chemoprevention uptake is low in Australia by international standards. This study identified barriers and facilitators not previously noted in the literature and that could suggest interventions. However, as in other studies, improving both clinician and patient knowledge may be the most important driver of interventions. Upskilling FDs is important as, in Australia, moderate risk women are not generally eligible for CGC consultation (despite their preference for one). Providing FDs and patients with tailored education resources and tools (such as iPrevent- www.petermac.org/iprevent) to improve their confidence and awareness of chemoprevention may reduce the gap between evidence and implementation. Conflict of interest: Other Substantive Relationships: KAP has a patent “System and Process of Cancer Risk Estimation” (Australian Innovation Patent) issued regarding iPrevent.