Secondary care support can boost GP use of breast cancer prevention drug

Researchers have called for a joint primary and secondary care pathway to encourage prescribing of tamoxifen as a preventative treatment for women at increased risk of breast cancer.

Prescription: GP prescribing of tamoxifen could rise (Photo: JH Lancy)
Prescription: GP prescribing of tamoxifen could rise (Photo: JH Lancy)

The call comes as use of the NICE-recommended drug in otherwise healthy women remains low, and a survey found that GPs are more reluctant to initiate the preventative therapy themselves than continue a prescription from secondary care.

Women with a family history are at increased risk of developing breast cancer, and NICE guidance recommends the use of selective oestrogen-receptor modulators – tamoxifen and raloxifene – to prevent the disease, even though these drugs are not licensed for primary prevention.

The study, published in the British Journal of General Practice (BJGP), comprised of an online survey answered by 928 GPs. The respondents were presented with one of four vignettes, during which the patient had either moderate or high risk of breast cancer and was presenting in primary or secondary care.

GP prescribing

The GPs were asked to indicate their willingness to prescribe tamoxifen, their comfort describing the harms and benefits and their awareness of the drug and associated NICE guideline in their assigned situation.

Only half (52%) of the GPs were aware that tamoxifen can reduce the risk of breast cancer and one quarter (24%) said they were familiar with the NICE guideline.

GP respondents who were asked to initiate prescribing were less willing to do so than those asked to continue a prescription started in secondary care.

The authors, from a number of UK universities including the University of Leeds, suggested that implementing a shared care agreement in which therapy is initiated in secondary care may help overcome some of the barriers to prescribing tamoxifen.

‘Developing a pathway involving both primary and secondary care in a shared care agreement could substantially increase GPs’ willingness to prescribe,’ they wrote.

Shared care

‘Although GPs may become more familiar with tamoxifen as a preventive agent over time, shared care agreements could form one facet of a longer-term implementation strategy.’

RCGP chair Professor Helen Stokes-Lampard 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.

‘But with clinical guidelines rightly being updated so frequently and given the incredibly broad spectrum of knowledge GPs need to have, it’s understandable that family doctors often take cues from our specialist colleagues in hospitals – so improved communication channels between primary and secondary care would certainly be helpful.’

In the UK, there are more than 53,000 new cases of breast cancer a year, with 11,000 dying from the disease annually.

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