Despite its efficacy in reducing breast cancer incidence, chemoprevention is underutilised. This survey study of Australian women and their clinicians used behavioural change theory to identify modifiable barriers to chemoprevention uptake, and to suggest interventions such as policy change, educational resources and public campaigns, that may increase awareness and use. Guidelines endorse the use of chemoprevention for breast cancer risk reduction. This study examined the barriers and facilitators to chemoprevention use for Australian women at increased risk of breast cancer, and their clinicians. Surveys, based on the Theoretical Domains Framework, were mailed to 1,113 women at ≥16% lifetime risk of breast cancer who were enrolled in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer cohort study (kConFab), and their 524 treating clinicians. Seven hundred twenty-five women (65%) and 221 (42%) clinicians responded. Only 10 (1.4%) kConFab women had ever taken chemoprevention. Three hundred seventy-eight (52%) kConFab women, two (3%) breast surgeons, and 51 (35%) family physicians were not aware of chemoprevention. For women, the strongest barriers to chemoprevention were side effects (31%) and inadequate information (23%), which operate in the Theoretical Domains Framework domains of “beliefs about consequences” and “knowledge,” respectively. Strongest facilitators related to tamoxifen's long-term efficacy (35%, “knowledge,” “beliefs about consequences,” and “goals” domains), staying healthy for family (13%, “social role” and “goals” domains), and abnormal breast biopsy (13%, “environmental context” domain). The strongest barrier for family physicians was insufficient knowledge (45%, “knowledge” domain) and for breast surgeons was medication side effects (40%, “beliefs about consequences” domain). The strongest facilitators for both clinician groups related to clear guidelines, strong family history, and better tools to select patients (“environmental context and resources” domain). Clinician knowledge and resources, and beliefs about the side-effect consequences of chemoprevention, are key domains that could be targeted to potentially enhance uptake. Prevention Relevance: Despite its efficacy in reducing breast cancer incidence, chemoprevention is underutilised. This survey study of Australian women and their clinicians used behavioural change theory to identify modifiable barriers to chemoprevention uptake, and to suggest interventions such as policy change, educational resources and public campaigns, that may increase awareness and use. See related Spotlight by Vogel, p. 1

中文翻译：

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乳腺癌化学预防：澳大利亚妇女及其临床医生的使用和看法

尽管化学预防能有效降低乳腺癌发病率，但并未得到充分利用。这项针对澳大利亚妇女及其临床医生的调查研究使用行为改变理论来确定化学预防吸收的可改变障碍，并提出可能提高认识和使用的干预措施，如政策改变、教育资源和公共活动。指南支持使用化学预防来降低乳腺癌风险。这项研究检查了澳大利亚乳腺癌风险增加的女性及其临床医生使用化学预防的障碍和促进因素。基于理论领域框架的调查已邮寄给 1,113 名乳腺癌终生风险≥16% 的女性，她们参加了凯瑟琳·康宁汉基金会家族性乳腺癌队列研究联盟 (kConFab)，和他们的 524 名治疗临床医生。725 名女性 (65%) 和 221 (42%) 名临床医生做出了回应。只有 10 (1.4%) 名 kConFab 女性接受过化学预防。三百七十八 (52%) 名 kConFab 女性、两名 (3%) 乳房外科医生和 51 名 (35%) 家庭医生不了解化学预防。对于女性来说，化学预防的最大障碍是副作用 (31%) 和信息不足 (23%)，它们分别在“对后果的信念”和“知识”的理论域框架域中起作用。与他莫昔芬的长期疗效（35%，“知识”，“对后果的信念”和“目标”领域）、保持家庭健康（13%，“社会角色”和“目标”领域）相关的最强促进因素，以及乳房活检异常（13%，“环境背景”域）。家庭医生最大的障碍是知识不足（45%，“知识”领域），而对于乳房外科医生来说，最大的障碍是药物副作用（40%，“对后果的信念”领域）。两个临床医生群体的最强促进者与明确的指南、强大的家族史和更好的选择患者的工具（“环境背景和资源”领域）有关。临床医生的知识和资源，以及关于化学预防副作用后果的信念，是可以针对潜在提高吸收的关键领域。预防相关性：尽管化学预防可有效降低乳腺癌发病率，但并未得到充分利用。这项针对澳大利亚妇女及其临床医生的调查研究使用行为改变理论来确定化学预防吸收的可改变障碍，并提出干预措施，例如政策变化、教育资源和公共运动，以提高认识和使用。参见 Vogel 的相关 Spotlight，第 10 页。1