OnCo
ideasIdea

Low-dose tamoxifen for high-risk women, prescribed by pharmacists and nurses

A 5 mg tamoxifen dose halves breast cancer recurrence after precancer with far fewer side effects than the full dose. Almost nobody is prescribed it. Change who can prescribe.

TAM-01 showed 5 mg a day reduced recurrence after DCIS, atypical hyperplasia or LCIS by about half with side effects close to placebo, yet uptake of risk-reducing medication is under 10%. Propose nurse and pharmacist prescribing, an automatic offer at diagnosis of high-risk lesions, and inclusion in screening-risk feedback.

Hypothesis
Automatic offer plus non-physician prescribing raises uptake of risk-reducing medication among eligible women from under 10% to at least 40%.
Rationale
The barriers are prescriber inertia and fear of side effects; low dose addresses the second, delegation the first.
What would test it
Run a cluster RCT in breast units.
Maturity
early clinical
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks

Key papers

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rctLancet Oncology 2015changed practice
IBIS-I: five years of tamoxifen keeps preventing breast cancer for at least 20 years

For women at raised risk, a 5-year course of tamoxifen offers long-lasting protection against the commonest kind of breast cancer. Uptake is low because of side effects and fear of rare serious harms; low-dose tamoxifen (TAM-01) is now being tested to improve the balance. It has not been shown to save lives.

Connected

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Pages like this

not linked directly; found by shared links

cancers

1
HR-positive / HER2-negative breast cancer

fronts

2
Hormonal TherapyPrevention & Risk

technologies

2
Chemoprevention & risk-reducing surgeryEndocrine therapy (SERMs, AIs, SERDs)

targets

1
Estrogen receptor (ERα)

bottlenecks

1
Prevention we already have is not deployed

key papers

1
IBIS-I: five years of tamoxifen keeps preventing breast cancer for at least 20 years