Is adjuvant tamoxifen used optimally in the treatment of breast cancer? Results of an Italian survey

Background: Institutional and physician-related factors can influence the w ay in which physicians interpret research results. The aim of this study wa s to determine what physicians know about, and their opinions of, hormone t reatment in breast cancer patients, and the factors comprising their medica l decision-making. Materials and methods: A questionnaire was mailed to a random sample of phy sicians inquiring as to their preferences with respect to adjuvant tamoxife n, and the usual duration of the treatment applied in various clinical scen arios (according to a woman's menopausal status, the oestrogen receptor sta tus and the stage of disease). Results: Of 500 physicians identified, 38% returned the questionnaire. Of t he non-responders, a random sample of 60 physicians was interviewed by phon e. The total number of available questionnaires was 250 (50%). About 3/4 of the doctors would prescribe tamoxifen in older ER+ women and 3 0%-40% in post-menopausal ER- patients, but only 2/5 would do so in younger ER+ women. The vast majority of physicians considered five years as standard for ER+ p atients. Nevertheless, about 1/4 of the doctors chose a shorter treatment d uration for node-negative, pre-menopausal patients. A minority of physician s used tamoxifen for longer than five years. Older clinicians were less lik ely to prescribe tamoxifen, particularly for low-risk patients. Conclusions: According to the data of the recent EBCTG overview, an additio nal 20,000 lives could be saved worldwide each year if tamoxifen were given to all early breast cancer patients with hormone-sensitive disease, irresp ective of age and disease stage, and for a minimum of five years. Our study, involving a representative sample of physicians practicing in It aly, shows that tamoxifen is not used optimally, with a substantial under-u se in younger women and women with node-negative disease.