Finding the five-year window: A qualitative study examining young women's decision-making and experience of using tamoxifen to reduce BRCA1/2 breast cancer risk.

Abstract

OBJECTIVE:

Tamoxifen has been demonstrated to reduce breast cancer risk in high-risk, premenopausal women. Yet, very few young women with hereditary breast and ovarian cancer syndrome in Australia use tamoxifen, despite this being a less-invasive option compared to risk-reducing mastectomy. This study aims to examine young women's decision-making about and experience of taking tamoxifen to reduce their breast cancer risk.

METHODS:

Young women with a BRCA1/2 mutation participated in semi-structured qualitative interviews, recruited mainly from a metropolitan clinical genetics service. Data were analysed using an inductive, team-based approach to thematic analysis.

RESULTS:

Forty interviews with women aged 20-40 years with a BRCA1/2 mutation were conducted. Eleven women could not recall discussing tamoxifen with their healthcare provider or were too young to commence cancer risk management. Twenty-three women chose not to use tamoxifen because it is contraindicated for pregnancy or because it did not offer immediate and great enough risk reduction compared to bilateral risk-reducing mastectomy. Six women who were definite about not wanting to have children during the following 5-year period chose to use tamoxifen, and most experienced none or transient side effects.

CONCLUSIONS:

Decision-making about tamoxifen was nuanced and informed by considerations characteristic of young adulthood, especially childbearing. Therefore, clinical discussions about tamoxifen with young women with a BRCA1/2 mutation must include consideration of their reproductive plans.

• Authors: Laura E Forrest, Rowan Forbes Shepherd, Mary-Anne Young, Louise A Keogh, Paul A James
• Journal: Psycho-oncology (Psychooncology) Vol. 30 Issue 2 Pg. 159-166 (02 2021) ISSN: 1099-1611 [Electronic] England
• PMID: 33006205 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 John Wiley & Sons Ltd.

Chemical References

• Tamoxifen

Topics

• Adult
• Australia
• Breast Neoplasms (genetics, prevention & control)
• Decision Making
• Female
• Genes, BRCA1
• Genes, BRCA2
• Genetic Predisposition to Disease (prevention & control)
• Humans
• Qualitative Research
• Reproduction
• Tamoxifen (therapeutic use)
• Young Adult