This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Peshkin, B. N. Articles by Schwartz, M. D. Search for Related Content PubMed PubMed Citation Articles by Peshkin, B. N. Articles by Schwartz, M. D.

Tamoxifen As Chemoprevention in BRCA1 and BRCA2 Mutation Carriers With Breast Cancer: A Pilot Survey of Physicians

Beth N. Peshkin, Claudine Isaacs, Clinton Finch, Sheryl Kent, Marc D. Schwartz

From the Georgetown University, Lombardi Comprehensive Cancer Center, Cancer Control Program, Washington, DC.

Address reprint requests to Beth N. Peshkin, MS, CGC, 2233 Wisconsin Ave, NW, Suite 317, Washington, DC 20007; e-mail: peshkinb{at}georgetown.edu.

Purpose: To assess physician recommendations about the use of tamoxifen in premenopausal BRCA1 and BRCA2 mutation carriers.

Methods: We mailed surveys to a stratified random sample of 1,286 physicians selected from the San Antonio Breast Cancer Symposium mailing list. Eligible participants were physicians whose practice consisted of 10% breast cancer patients. Participants were asked to complete a three-part, 10-minute questionnaire. Demographics and responses to hypothetical patient vignettes were analyzed.

Results: Of potentially eligible participants, 27% responded to the survey, and 260 participants were included in the final analysis. Physicians did not distinguish between BRCA1 and BRCA2 status in making recommendations about tamoxifen to breast cancer patients; however, in an unaffected woman, they were more likely to recommend tamoxifen to a BRCA2 mutation carrier than to a BRCA1 mutation carrier (73% v 57%; P < .0001). In newly diagnosed breast cancer patients, physicians were much more likely to recommend tamoxifen to an estrogen receptor (ER)–positive mutation carrier versus an ER-negative carrier (94% v 27%; P < .0001). When the mutation carrier was diagnosed 10 years ago, physicians were still much more likely to recommend tamoxifen if the tumor was ER-positive versus ER-negative (79% v 35%; P < .0001).

Conclusion: Physicians’ recommendations about tamoxifen use in mutation carriers with a history of breast cancer seem to be heavily dependent on ER status. This finding suggests that among mutation carriers, physicians are influenced by adjuvant treatment guidelines more so than the potential role that tamoxifen might play in the reduction of risk for contralateral breast cancer.

Supported by American Cancer Society Institutional Research grant no. IRG 97-152-04 (to B.N.P.) and the Cancer Genetics Network, NIH/NCI grant no. 1 U24 CA78146-04 (to C.I.).

This article has been cited by other articles:

				S. K. Plevritis, A. W. Kurian, B. M. Sigal, B. L. Daniel, D. M. Ikeda, F. E. Stockdale, and A. M. Garber Cost-effectiveness of screening BRCA1/2 mutation carriers with breast magnetic resonance imaging. JAMA, May 24, 2006; 295(20): 2374 - 2384. [Abstract] [Full Text] [PDF]

				J. E. Garber and A.-R. Hartman Prophylactic Oophorectomy and Hormone Replacement Therapy: Protection at What Price? J. Clin. Oncol., March 15, 2004; 22(6): 978 - 980. [Full Text] [PDF]