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Center for Healthcare Policy and Research

Center for Healthcare Policy and Research

Tamoxifen prevention of breast cancer: what is cost effective?

Principal Investigator
PI Home Department
Source of Support
Dates
Total Cost
Joy Melnikow, M.D.
Family and Community Medicine
National Cancer Institute
*on non cost extension
$577,591

Breast cancer is the second leading cause of death from cancer among women in the U.S. Interest in methods of preventing breast cancer is high. In 1998, the National Cancer Institute reported a 50% reduction in the incidence of breast cancer in women taking tamoxifen enrolled in the tamoxifen for breast cancer prevention trial. Numerous concerns remain regarding tamoxifen, including whether this preventive approach is acceptable to women at risk. In July 1999, the Breast Cancer Research Program (BCRP) funded “Tamoxifen Prevention: Is it acceptable to women at risk?” to develop a deeper understanding of how a diverse group of high- risk women weigh risk versus benefits in considering tamoxifen prevention. The study explored how information such as self-perceived breast cancer risk, NCI screening tool determined breast cancer risk, and education affect and influence women’s decisions.

A structured interview (English or Spanish) combined qualitative and quantitative items and a standardized educational intervention describing potential beneficial and harmful outcomes of taking tamoxifen for breast cancer risk reduction was provided. 771 women were screened, 341 (44.2%) met eligibility criteria, and 255 (33.1%) completed interviews (76.9% White, 3.9% African American, 10.6% Latina, 7.0% Asian, 1.6% Native American). Interviewed women’s estimated mean five-year breast cancer risk was 2.8% and mean self-perceived 5-year risk was 32.7%. A minority of interviewed women were interested in tamoxifen following education and few shifted their previous inclination.

A cost effectiveness analysis of the use of tamoxifen for breast cancer risk reduction will use standard gamble utilities collected during the BCRP interview study. This analysis, funded by the National Cancer Institute, is still in progress.