Table 3 Enablers to the discussion of chemoprevention in Family Cancer Centres with supporting quotes

'Reasonable' evidence in BRCA2 carriers

5C (med oncologist)

17

I think that in a BRCA2 mutation carrier we'll discuss Tamoxifen- I'm a bit more confident about Tamoxifen with a BRCA2, than in a BRCA1.

Side-effects less in younger women

1A (med oncologist)

18

...side effects at that age [45] are likely be to be small in absolute terms

PRACTICE

Enroling people on a trial is convenient

1B (med oncologist)

19

When the IBIS I study was recruiting that would be definitely part of my discussion because there was a study that they could participate in to try and get an answer. But then that closed so there's been a window between now and then [-]... There's sort of been a bit of a lull.

Not expensive

5C (med oncologist)

20

identified that not being PBS-listed was not a constraint to prescribing Tamoxifen because it 'is not an expensive drug'

PERCEPTION

Action of Tamoxifen to reduce risk 'intuitively makes sense'

5C (med oncologist)

21

But intuitively, I can understand how um, Tamoxifen would reduce the risk.

Lack of 'hard data' is not always a barrier to recommending something

5C (med oncologist)

5A (clinical geneticist)

22

5A Breast ultrasound? If you're having MRI? No, but if you aren't having it, then, there's very little hard data...

5C I know there's no hard data but that's never stopped anyone doing anything