The findings of a new study suggest a substantial number of women at risk of breast cancer are not receiving tamoxifen chemoprevention despite being recommended by NICE.
Tamoxifen was recommended by NICE in 2013 for chemoprevention of breast cancer, but a recent survey suggested only a quarter of GPs are aware of this. Researchers from the University of Oxford analysed data on tamoxifen and raloxifene prescribing using England's monthly prescribing data sets from October 2010 to October 2017.
They found a gradual increase in the rate of tamoxifen prescribing following release of the guidelines, estimated to account for 8,450 patients over 2.5 years, which they say represents just 17 per cent of the potential overall uptake.
Between October 2010 and May 2013, the rate of tamoxifen prescribing was approximately constant, at around 137 average daily quantities (ADQs) prescribed per 1000 population per month (gradient 0.072; P=.441). Following the release of guidelines in June 2013 recommending the additional use of tamoxifen for chemoprevention, there was no immediate step change in prescribing (P=.342). However, there was a significant change in the slope between June 2013 and December 2016 (+0.330; P=.001).
The results suggest that not all women at increased risk of breast cancer have been offered tamoxifen chemoprevention, potentially leaving them at risk, they conclude.
Presenting the findings in the British Journal of Cancer, the authors say: “Our results suggest that the uptake of new guidance on chemoprevention has been slow and has potentially left women exposed to avoidable risk. Improving dissemination of guidance to healthcare professionals and routinely monitoring implementation could help reduce this risk.”
