Prescription of tamoxifen for breast cancer prevention by primary care physicians
Prescription of tamoxifen for breast cancer prevention by primary care physicians
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DOI：
10.1001/archinte.166.20.2260
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发表时间：
2006-11-13
影响因子：
--
通讯作者：
Guerra, Carmen
中科院分区：
文献类型：
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作者：
Armstrong, Katrina;Quistberg, D. Alex;Guerra, Carmen
背景：自1998年以来，柠檬酸他莫昔芬已被批准用于降低乳腺癌风险，但初级保健医生对他莫昔芬的处方知之甚少。方法：为了调查初级保健医生开他莫昔芬预防乳腺癌处方的决定因素，我们向350名初级保健医生邮寄了一份全国性调查，内容包括家庭实践、妇产科和普通内科，关于过去他莫昔芬的处方，在假设情景下开他莫昔芬的意图，以及潜在的诱因和诱发因素。结果：96名(27.4%)医生报告在过去12个月中至少开过一次他莫昔芬预防乳腺癌的处方。经多因素调整后，开过他莫昔芬处方的患者与有患乳腺癌的家庭成员的医生(优势比，2.66；95%可信区间[CI]，1.21-5.85)、询问他莫昔芬信息的患者(OR，3.98；95%CI，1.44-11.04)、相信他莫昔芬的益处大于风险(OR，1.86；95%CI，1.07-3.24)以及合格性易于确定(OR，2.67；95%CI，1.35-5.29)有关。在假设的情况下，他莫昔芬的处方受患者乳腺癌家族史的影响，但不受她患子宫内膜癌的风险(即子宫切除状况)的影响。结论：少数初级保健医生开了他莫昔芬预防乳腺癌的处方。开他莫昔芬的决定受确定资格、患者需求和个人乳腺癌治疗经验的能力以及对风险和益处的看法的影响。与乳腺癌风险的大小相比，三苯氧胺对妇女患子宫内膜癌的风险对处方决策的影响似乎更小。结论：少数初级保健医生已将他莫昔芬用于预防乳腺癌。开他莫昔芬的决定受确定资格、患者需求和个人乳腺癌治疗经验的能力以及对风险和益处的看法的影响。与乳腺癌风险的大小相比，三苯氧胺对女性患子宫内膜癌的风险对处方决策的影响似乎更小。
Background: Although tamoxifen citrate has been approved for primary reduction of breast cancer risk since 1998, little is known about the prescription of tamoxifen by primary care physicians.Methods: To investigate the determinants of prescription of tamoxifen for breast cancer prevention by primary care physicians, we mailed a national survey to 350 primary care physicians, including specialties of family practice, obstetrics and gynecology, and general internal medicine, regarding past prescription of tamoxifen, intention to prescribe tamoxifen in hypothetical scenarios, and potential predisposing and enabling factors.Results: Ninety-six physicians (27.4%) reported having prescribed tamoxifen for breast cancer prevention at least once in the prior 12 months. After multivariate adjustment, having prescribed tamoxifen was associated with the physician having a family member with breast cancer ( odds ratio [OR], 2.66; 95% confidence interval [CI], 1.21-5.85), patients who asked for information about tamoxifen ( OR, 3.98; 95% CI, 1.44-11.04), and the beliefs that the benefits of tamoxifen outweighed the risks ( OR, 1.86; 95% CI, 1.07-3.24) and that eligibility was easy to determine ( OR, 2.67; 95% CI, 1.35-5.29). In hypothetical scenarios, the prescription of tamoxifen was affected by the patient's family history of breast cancer but not by her risk for endometrial cancer (ie, hysterectomy status). Conclusions: A minority of primary care physicians have prescribed tamoxifen for breast cancer prevention. The decision to prescribe tamoxifen is affected by the ability to determine eligibility, patient demand, and personal experience with breast cancer as much as perceptions of the risks and benefits. A woman's risk of endometrial cancer from tamoxifen seems to have less impact on prescribing decisions than the magnitude of her breast cancer risk.Conclusions: A minority of primary care physicians have prescribed tamoxifen for breast cancer prevention. The decision to prescribe tamoxifen is affected by the ability to determine eligibility, patient demand, and personal experience with breast cancer as much as perceptions of the risks and benefits. A woman's risk of endometrial cancer from tamoxifen seems to have less impact on prescribing decisions than the magnitude of her breast cancer risk.