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Implications for Chemoprevention

Carmen L. Lewis, MD, MPH; Linda S. Kinsinger, MD, MPH; Russell P. Harris, MD, MPH; Robert J. Schwartz, MA

Arch Intern Med. 2004;164:1897-1903.

Background  Some women may benefit from taking tamoxifen citrate for breast cancer prevention if the probability of benefit outweighs that of adverse events. We determined the proportion of women aged 40 to 69 years attending general internal medicine practices who were potentially eligible for tamoxifen chemoprevention and calculated the maximum proportion of breast cancers that could be prevented.

Methods  Six hundred five women aged 40 to 69 completed self-administered questionnaires in the waiting rooms of 10 general internal medicine practices in North Carolina in 2001.

Results  Among white women, 9.0% (95% confidence interval [CI], 5.1%-15.2%) in their 40s, 24.0% (95% CI, 18.2%-31.0%) in their 50s, and 53.4% (95% CI, 46.1%-61.3%) in their 60s had a 5-year Gail model estimated breast cancer risk of 1.66% or greater. Among black women, 2.9% (95% CI, 0%-15.0%) in their 40s, 7.1% (95% CI, 1.1%-24.4%) in their 50s, and 13.0% (95% CI, 3.1%-34.3%) in their 60s had a similar risk. When adverse events were considered in white women, 10% or fewer in all age groups were potentially eligible for chemoprevention. The maximum proportion of breast cancers prevented in eligible women was 6.0% to 8.3%.

Conclusions  Small numbers of women in primary care practices are eligible for discussions about chemoprevention; the maximum proportion of breast cancers prevented if eligible women take tamoxifen is also small. Challenges lie in targeting discussions to the most appropriate women and in finding new chemoprevention strategies that have less risk of harms.

From the Division of General Medicine and Clinical Epidemiology, Department of Medicine (Drs Lewis and Harris), and Cecil G. Sheps Center for Health Services Research (Dr Harris and Mr Schwartz), The University of North Carolina at Chapel Hill; and VA National Center for Health Promotion and Disease Prevention, Durham, NC (Dr Kinsinger). The authors have no relevant financial interest in this article.

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