Clinician-Reported Barriers to Implementing Breast Cancer Chemoprevention in the UK: A Qualitative Investigation

Samuel G. Smith, Lucy Side, Susanne F. Meisel, Rob Horne, Jack Cuzick, Jane Wardle
2016 Public Health Genomics  
scription if it had been started in secondary or tertiary care. Conclusions: Barriers to implementing preventive therapy within routine clinical practice are common and could be addressed by engaging all stakeholders during the development of policy documents. Background Breast cancer is the most commonly diagnosed cancer in developed countries, and incidence is increasing worldwide [1] . Treatment advances have improved survival [2, 3] , but primary prevention can play a role in reducing
more » ... e burden. Preventive therapy using Selective Oestrogen-Receptor Modulators (SERMs) such as tamoxifen and raloxifene can reduce incidence of breast cancer by 30% or more among higher-risk women [4] . SERMs also increase the risk of a thromboembolic event, endometrial cancer, and menopausal side effects. A meta-analysis reported that 16% of women accepted the offer of preventive therapy [5] , but most were US studies and initiation in the UK may be lower [6] . Uptake to preventive therapy trials is higher than initiation rates observed in clinical settings [5] . Abstract Aims: The use of tamoxifen and raloxifene as preventive therapy for women at increased risk of breast cancer was approved by the National Institute for Health and Care Excellence (NICE) in 2013. We undertook a qualitative investigation to investigate the factors affecting the implementation of preventive therapy within the UK. Methods: We recruited general practitioners (GPs) (n = 10) and clinicians working in family history or clinical genetics settings (FHCG clinicians) (n = 15) to participate in semi-structured interviews. Data were coded thematically within the Consolidated Framework for Implementation Research. Results: FHCG clinicians focussed on the perceived lack of benefit of preventive therapy and difficulties interpreting the NICE guidelines. FHCG clinicians felt poorly informed about preventive therapy, and this discouraged patient discussions on the topic. GPs were unfamiliar with the concept of preventive therapy, and were not aware that they may be asked to prescribe it for high-risk women. GPs were reluctant to initiate therapy because it is not licensed, but were willing to continue a pre-
doi:10.1159/000447552 pmid:27399355 fatcat:3znzil2jiffebhewmfihefrxua