'Worrying' Number Of Doctors Not Offering Preventative Breast Cancer Drug To At-Risk Patients | HuffPost Life

'It is extremely concerning.'

Press Association

Many family doctors aren’t offering at-risk patients a preventative breast cancer drug, a charity has said.

The comments from Breast Cancer Now come as a new study found that only half of GPs were aware that the drug tamoxifen could be used to reduce the risk of breast cancer.

In 2013, the National Institute for Health and Care Excellence (NICE) recommended that women deemed to be at moderate or high risk of breast cancer should be offered chemoprevention drugs - including tamoxifen.

But a new research paper found that just over half of GPs knew that the medication could be used in this way.

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The study, published in the British Journal of General Practice, found that three quarters of GPs were not aware of the Nice guidelines.

Researchers presented respondents with a series of scenarios where a healthy patient was seeking a tamoxifen prescription.

They found just 51.7 % of the GPs knew the drug can reduce breast cancer risk, while only 24.1% said they were aware of the relevant professional advice.

The authors, who assessed online responses from 928 family doctors from England, Northern Ireland and Wales, found that GPs are more comfortable in discussing, and more willing to prescribe or recommend these drugs, if supported by hospital doctors.

Commenting on the study, Baroness Delyth Morgan, chief executive at Breast Cancer Now, said: “It is extremely concerning that many women at an increased risk of breast cancer are still not being offered the choice of taking tamoxifen to reduce their risk.

“Nice’s 2013 guideline recommended that it be offered to all women at medium and high risk of the disease.

“But unfortunately this is largely not being adhered to, with many GPs lacking confidence in discussing the option with patients and a worrying number not even being aware of it.

“Given the current debate on the increasing patient demand on the NHS, it is essential that we make the most of low-cost preventive measures such as tamoxifen.

“This study highlights that greater support needs to be offered to GPs in prescribing off-patent drugs in new uses.

“Ultimately, while not all women will want to take tamoxifen as it has side-effects as well as benefits, it’s imperative that they are offered the choice and given all the information they need to make an informed decision.”

Cancer Research UK (CRUK) called for better support for GPs.

The tamoxifen study forms part of a new CRUK report which also looks at other cancer preventing drugs.

The report highlights that 73% of GPs know that aspirin could reduce the risk of bowel cancers in people who are not at high risk.

And among GPs who had heard of Lynch Syndrome - a genetic condition which can increase a person’s risk of bowel cancer, cancer of the womb and some other cancers - just under half knew that aspirin could reduce the risk of cancers linked to the syndrome.

The report makes a number of recommendations to ensure cancer preventing drugs are routinely discussed with and offered to patients who may benefit.

NHS Digital data shows there were 662,264 prescriptions dispensed for tamoxifen in 2015.

Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “The benefits of using long-term medication to lower the risk of developing cancer are becoming clearer as new research findings become available – and it’s important that this informs official clinical guidelines, and that GPs and our teams are aware of them.

“But with clinical guidelines rightly being updated so frequently and given the incredibly broad spectrum of knowledge GPs need to have, it’s understandable that family doctors often take cues from our specialist colleagues in hospitals – so improved communication channels between primary and secondary care would certainly be helpful.

“Ultimately, any decision to prescribe drugs to patients must be the result of a full and frank conversation between doctor and patient, taking into account the latest clinical guidelines, considering all the positives and negatives, but also based on a patient’s unique circumstances and family history in order to achieve the best possible health outcome for that patient.

“Cancer is an enduring priority for the College, in partnership with Cancer Research UK, and we have developed a wide range of resources to support GPs in the timely identification of cancer, and keep up to date with the latest clinical guidelines and information in this area.”

Breast Cancer Signs And Treatment

What Are The Symptoms?(01 of10)

"A new painless, firm breast lump with irregular margins is a potential symptom of breast cancer," says Dr. Sandhya Pruthi, a breast cancer researcher at the Mayo Clinic. "The cancer diagnosis is confirmed following a biopsy of the lump." She notes that usually, women who are newly diagnosed with breast cancer are healthy and don't feel sick at all. (credit:LarsZahnerPhotography via Getty Images)

Other Symptoms(02 of10)

Another potential symptom/sign of breast cancer, Pruthi notes, is a new onset of persistent redness on the skin overtop the breast with an orange peel appearance. This would also need a biopsy to confirm a diagnosis of breast cancer. (credit:Image Source via Getty Images)

Metastatic Cancer Symptoms(03 of10)

"If the cancer is very advanced (metastatic) then the symptoms may also include weight loss, bone pain, headaches, nausea and persistent cough," Pruthi says. (credit:pamela burley via Getty Images)

What Are The Risk Factors?(04 of10)

Some commonly associated risk factors, Pruthi says, are menstruation before age 11, menstruation after age 54, a first pregnancy after age 35 and a family history of relatives diagnosed with breast or ovarian cancer. (credit:AP Photo/M. Spencer Green)

Are There Any Lifestyle Risk Factors?(05 of10)

"There is evidence in the literature that obesity after menopause, lack of regular exercise, consuming greater than more or more alcoholic beverages daily, and a high fat diet can all be associated with a higher breast cancer risk," Pruthi notes. But, she points out, "women need to know that any woman can get breast cancer even in the absence of any of these risk factors." (credit:Adrian Samson via Getty Images)

Can I Eat Anything To Prevent It?(06 of10)

There are no specific types of diets, Pruthi says, but rather women are encouraged to eat fruits, vegetables, fibre, and minimize their alcohol and fat intake, as well as get regular exercise. (credit:lola1960 via Getty Images)

How Do Doctors Determine Treatment?(07 of10)

"The most current treatment of breast cancer has taken on a individualized approach and is dependent on the biology or aggressive features of the breast cancer," Pruthi explains. "Breast cancer is a heterogeneous disease and this means that are many sub-types and different degrees of aggressiveness. So staging, which typically takes into account common prognostic features such as tumour size and if lymph nodes are involved, are no longer the only factors doctors use to determine treatment options." (credit:Christopher Futcher via Getty Images)

So What Do They Look At?(08 of10)

"Today the biology of the tumour is also characterized by molecular markers (also known as predictive markers) such as if the estrogen or progesterone receptor is positive or negative and if the HER 2 protein is positive or negative," she says. "This helps decide who will benefit from a specific chemotherapy regimen, hormonal medications known as antiestrogens or who may need both chemotherapy and hormonal treatment." (credit:BluePlanetEarth via Getty Images)

What About Preventative Mastectomies?(09 of10)

"Preventive mastectomy is an option for women at very high risk for developing breast cancer because they are BRCA 1 or 2 gene positive or if someone has hereditary predisposition to getting breast cancer but chooses not to have the genetic testing done," Pruthi says. "It is prudent that women who are considering this surgery know their family history in detail. Based on the moderate or strong family history, your doctor would recommend you meet with a genetic counselor to go over the family pedigree and help decide who should test for the breast cancer gene, when to test and how to interpret the genetic test results before proceeding with this preventive surgery." (credit:JesÃºs Jaime Mota via Getty Images)

Are Other Preventative Treatments Available?(10 of10)

"High risk women who have had precancerous breast biopsies or strong family history may also be eligible to take preventive medications such as tamoxifen, raloxifene or exemestane to reduce breast cancer risk," Pruthi adds. (credit:art-4-art via Getty Images)

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