Table 1.

Ten-item questionnaire on the reasons why physicians are reluctant to prescribe tamoxifen or raloxifene for breast cancer therapeutic prevention

S1There is no evidence of a reduction in breast cancer mortality.
S2Drugs such as tamoxifen or raloxifene can cause serious side effects, including endometrial cancer and venous thromboembolism.
S3There are no reliable short-term biomarkers to measure efficacy such as blood pressure or cholesterol, which are used in cardiovascular preventive medicine.
S4It is unclear as to who is the most appropriate physician to take care of women at risk for breast cancer among medical oncologists, gynecologists, family doctors and surgeons.
S5Current composite risk factor models, such as the Gail model or the Tyrer–Cuzick model, are not readily available for clinical practice.
S6There is little knowledge in the medical community of the efficacy of drugs such as tamoxifen, raloxifene as preventive agents.
S7Current drugs can only prevent endocrine-responsive tumors, which can mostly be cured by surgery and adjuvant therapy.
S8There is no commercial interest to support these treatments by drugs companies as all approved drugs are out of patent.
S9The use of these drugs has not been approved in Europe, and its prescription outside the United States and Canada is off label.
S10A recent trial (MAP3) has suggested that aromatase inhibitors are very active in preventing breast cancer. Confirmation in a second trial will substantially increase prescription of these agents for prevention.