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Hered Cancer Clin Pract. 2017 Sep 20;15:14. doi: 10.1186/s13053-017-0075-8. eCollection 2017.

Motivators and barriers of tamoxifen use as risk-reducing medication amongst women at increased breast cancer risk: a systematic literature review.

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Prince of Wales Clinical School, UNSW, Level 4, Lowy Cancer Research Centre C25, Sydney, NSW 2052 Australia.
School of Social Sciences and Prince of Wales Clinical School, UNSW Sydney, Kensington, NSW 2052 Australia.
Department of Obstetrics and Oncology, Royal Women's Hospital, University of Melbourne, Melbourne, VIC 3052 Australia.
Institut Paoli-Calmettes, Marseille, France.
Familial Cancer Service, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145 Australia.
Westmead Millennium Institute for Medical Research at the University of Sydney, PO Box 412, Westmead, NSW 2145 Australia.
Sir Peter MacCallum Dept of Oncology, University of Melbourne, Parkville, VIC 3010 Australia.
Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, VIC 8006 Australia.



Selective estrogen receptor modulators, such as tamoxifen, reduce breast cancer risk by up to 50% in women at increased risk for breast cancer. Despite tamoxifen's well-established efficacy, many studies show that most women are not taking up tamoxifen. This systematic literature review aimed to identify the motivators and barriers to tamoxifen use 's amongst high-risk women.


Using MEDLINE, PsycINFO, and Embase plus reviewing reference lists of relevant articles published between 1995 and 2016, 31 studies (published in 35 articles) were identified, which addressed high-risk women's decisions about risk-reducing medication to prevent breast cancer and were peer-reviewed primary clinical studies.


A range of factors were identified as motivators of, and barriers to, tamoxifen uptake including: perceived risk, breast-cancer-related anxiety, health professional recommendation, perceived drug effectiveness, concerns about side-effects, knowledge and access to information about side-effects, beliefs about the role of risk-reducing medication, provision of a biomarker, preference for other forms of breast cancer risk reduction, previous treatment experience, concerns about randomization in clinical trial protocols and finally altruism.


Results indicate that the decision for high-risk women regarding tamoxifen use or non-use as a risk-reducing medication is not straightforward. Support of women making this decision is essential and needs to encompass the full range of factors, both informational and psychological.


Breast cancer; High risk; Prevention; Risk-reducing medication; Tamoxifen

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