Half of GPs unaware of drug’s use in cancer prevention

Credit: This story was first seen on The Guardian

A ‘worrying’ number of family doctors are not offering at-risk patients a preventive breast cancer drug, a charity has said.

A study found that only half of GPs were aware the drug tamoxifen could be used to reduce the risk of breast cancer, The Guardian reports.

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 the new research found that just over half of GPs knew the medication could be used in this way. The study, published in the British Journal of General Practice, also found that three-quarters of GPs were not aware of the Nice guidelines.

Delyth Morgan, chief executive of the charity 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. 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.”

The study involved online responses from 928 family doctors from England, Northern Ireland and Wales.

The researchers presented respondents with a series of scenarios in which a healthy patient was seeking a tamoxifen prescription.

They found 51% of the GPs knew the drug could reduce breast cancer risk, and 24% said they were aware of the relevant professional advice.

They found GPs were more comfortable discussing and more willing to prescribe or recommend these drugs if supported by hospital doctors. Cancer Research UK(CRUK) called for better support for GPs.

The tamoxifen study formed part of a CRUK report that also looks at other cancer-preventing drugs. The report says 73% of GPs know that aspirin could reduce the risk of bowel cancer in people who are at high risk.

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Among GPs who had heard of the Lynch syndrome – a genetic condition that 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.

Its author, Dr Samuel Smith, a CRUK fellow at the University of Leeds, said: “Our report helps us to understand GP attitudes towards the use of cancer-preventing drugs. It’s clear that more needs to be done to promote the evidence and guidance associated with these drugs, particularly as research reveals GPs are lacking the support to discuss effectively the risks and benefits of preventive therapy.”

Professor Arnie Purushotham, CRUK’s senior clinical adviser, said: “Cancer-preventing drugs have the potential to have a huge impact by reducing the risk of cancer developing in the first place. This report reveals that it’s vital that GPs are given the right support and information so they are confident to explore the value of these drugs with those who would benefit from them, wherever they are in the UK.

“While this study focuses on reducing cancer risk, chemoprevention can also be used to reduce the risk of some cancers returning or spreading. It’s essential that the NHS provides a clear steer to doctors to ensure all patients have equal access to treatments that could benefit them.”

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

Professor Helen Stokes-Lampard, chair 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.”