What Is the Most Important Factor Women Consider in Deciding on SERM Use to Reduce Their Risk of Breast Cancer?


Key Points

  • A health-care professional’s recommendation was the most important factor in helping women at high risk for breast cancer decide to take a selective estrogen receptor modulator (SERM) to reduce their cancer risk.
  • The odds of SERM use when recommended by a health-care provider were higher for women with a positive attitude toward taking these medications than for those with a negative attitude.

Currently, two medications have been approved by the U.S. Food and Drug Administration to reduce the risk of breast cancer: tamoxifen and raloxifene. Both medications, selective estrogen receptor modulators (SERMs), have been shown to reduce the risk for breast cancer by up to 50% in prevention clinical trials. In 2013, ASCO issued its updated guideline on interventions to reduce breast cancer risk in women at an increased risk for the disease and new insight on the risks and benefits of tamoxifen and raloxifene use in postmenopausal women.

Despite these efforts, adoption of SERMs as prevention medication remains low. A study investigating the factors that influence a woman’s decision to use a SERM to reduce her breast cancer risk has found that a health-care professional’s recommendation to take a SERM was the most important driver in her decision. Other reasons included attitudes about taking medication, worry about developing breast cancer, trust in the health-care professional, having a family member with blood-clotting concerns, and knowledge about the experience of others who had taken SERMs. The study by Holmberg et al was published in Cancer Prevention Research.

Study Methodology

The investigators surveyed 1,023 women in community care settings between 2011 and 2013. Most of the women were over age 50, white, and considered to be postmenopausal (64%). The study participants were asked to complete a survey at two time points: immediately after a counseling session with a health-care professional and after they decided to take a SERM or not.

The surveys assessed the content of the counseling session with the health-care provider, including the range of treatment options for risk reduction and which risks and benefits of SERMs were discussed. In addition, perceptions about SERMs, participants’ experiences with breast cancer, blood clotting, cataracts, endometrial cancer, osteoporosis, and sociodemographic factors were evaluated.

Study Findings

The researchers’ analysis showed that of the 1,023 participants in the survey, 726 made a decision: 324 (44.6%) decided to take a SERM, and 402 (55.4%) decided not to take a SERM. Other characteristics associated with the decision included attitudes and perceptions regarding medication intake, worry about breast cancer, trust in the health-care provider, family members with blood clots, and others’ experiences with SERMs.

The odds of SERM intake when a health-care provider recommended its use were higher for participants with a positive attitude toward taking medications than for those with a negative attitude (P = .01).

“This study highlights the importance of social and cultural aspects for SERM decision-making, most importantly, personal beliefs and experiences. Health-care providers’ recommendations play a statistically significant role in decision-making and are more likely to be followed if in line with patients’ attitudes. [The] results indicate the need for developing interventions for health-care providers that not only focus on the presentation of medical information, but, equally as important, on addressing patients’ beliefs and experiences,” concluded the study authors.

Christine Holmberg, PhD, MPH, of the Institute of Public Health Charité-Universitätsmedizin Berlin, Germany, is the corresponding author of this study.

Funding for this study was provided by the National Cancer Institute.


The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.