Originally published as JCO Early Release 10.1200/JCO.2004.05.192 on December 14 2004

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Decision-Making About Tamoxifen in Women at High Risk for Breast Cancer: Clinical and Psychological Factors

From the Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.

Address reprint requests to Sharon L. Bober, PhD, Dana-Farber Cancer Institute, David B. Perini Quality of Life Clinic, D321, 44 Binney St, Boston, MA 02115; e-mail: sharon_bober{at}dfci.harvard.edu

PURPOSE: To explore the health-related and psychological factors that influence decision making about tamoxifen (Nolvadex; AstraZeneca, Waltham, MA) chemoprevention in women at increased risk for developing breast cancer.

METHODS: This study involves the assessment of 129 women eligible to take tamoxifen following cancer-risk counseling. Treatment decision and decision satisfaction were measured at 2 and 4 months following counseling. Health-related factors included physician recommendation, personal and family-related health history, and concern about side effects. Psychological factors included breast cancer–related anxiety, risk perception, and depression.

RESULTS: At 2 months’ follow-up, 44% of participants declined tamoxifen treatment. This number increased to 49% at 4 months. Personal and family health history were not related to the decision, but history of abnormal biopsy did predict tamoxifen use. Physician recommendation was highly correlated with treatment decision. Concern about side effects was related to the decision to decline treatment. Breast cancer–related anxiety and heightened risk perception were associated with the decision to take tamoxifen. However, anxiety and psychological distress were also negatively related to treatment satisfaction.

CONCLUSION: Decision-making about tamoxifen is complex, and many eligible women decline treatment or remain undecided. Findings call for further educational follow-up with high-risk women after they undergo initial counseling. Factors related to misperceptions of risk and side effects, as well as psychological distress, may be particularly important targets for intervention.

Supported by a grant from the Massachusetts Breast Cancer Research Grant Program (S.L.B.).

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

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