A new era for cancer prevention

In June 2013 you may have seen headlines about two new drugs that are going to be offered to women who are at an increased risk of breast cancer. These drugs, known as Tamoxifen and Raloxifene, were previously used by women who had been diagnosed with breast cancer as a way of reducing recurrence of the disease. Recent data suggest that these medications may be beneficial for women with a strong family history. As a result, the National Institute for Health and Care Excellence (NICE) has recommended that they be offered to women who meet a certain level of risk based on their family history and other factors.

Taking medications or any other natural, synthetic or biological agent to prevent cancer is known as ‘chemoprevention’. The NICE announcement was particularly exciting because it is the first time they have endorsed a medication for the primary prevention of cancer. While this raises a number of clinical issues, I have recently been given funding from Cancer Research UK to investigate what women think of breast cancer chemoprevention. Women who have been assessed by a specialist and told they are at an increased risk of breast cancer have a number of options, including taking Tamoxifen or Raloxifine. Alternatives include doing nothing, having routine surveillance by mammography or surgical intervention to remove the breasts and/or ovaries. You may have seen newspaper coverage of Angelina Jolie making a similar decision and here is her thoughtful piece on the issue. This decision is challenging, and there is no right or wrong answer. Instead, it must be based on women’s full understanding of the risks and benefits, as well as the values they assign to these factors.

In a joint collaboration between the Health Behaviour Research Centre, and the Centre for Cancer Prevention and funded by Cancer Research UK, I will be recruiting and following a group of women who have been asked to decide between these options. This study (known as the ENGAGE study) will help to identify how women are currently making these decisions, and what can be done to support them during this difficult process. Data from a number of questionnaires will be collected and after 1 year we will report on what decisions women have made and what their experience has been.

Chemoprevention is an exciting new area of research, but understanding the public’s opinion of it is vital if it is to be implemented effectively. So, if you’d like offer an opinion please feel free to leave a comment on our message board or contact me directly via e-mail (samuel.smith@ucl.ac.uk).

Sam (samuel.smith@ucl.ac.uk)