A new Cancer Research UK report reveals that GPs want more support when offering drugs that lower the risk of certain cancers.
The report explores how much GPs know about two drugs that can reduce the risk of cancer – tamoxifen for women at high risk of breast cancer and aspirin for people with Lynch Syndrome, a condition that increases the risk of several types of cancer.*
It finds that GPs are more comfortable in discussing, and more willing to prescribe or recommend these drugs, if supported by secondary care clinicians.
Since 2013 NICE has recommended tamoxifen to prevent breast cancer among women with a clear family history of the disease, meaning that they are at a higher risk. But, the report revealed that only just over half of the 1,000 GPs** surveyed knew that tamoxifen could be used in this way.
Only 24 per cent were aware of the NICE familial breast cancer guidelines and 20 per cent of Scottish GPs were aware of similar Healthcare Innovation Scotland guidelines.
Even with this low awareness, the report reveals that more than three-quarters of GPs were willing to prescribe tamoxifen, and many would be more comfortable if they knew a secondary care clinician had written the first prescription.
In contrast, 73 per cent of GPs knew that aspirin could reduce the risk of bowel cancers in people who are not at high risk. But among GPs who had heard of Lynch Syndrome, just under half knew that aspirin could reduce the risk of cancers linked to the syndrome.
The report makes a number of recommendations to ensure cancer preventing drugs are routinely discussed with and offered to the people who may benefit.
It calls on NICE and NHS England (and national equivalents) to promote the evidence and existing guidance on chemoprevention along with the potential benefits and harms of these drugs. It highlights the role of Cancer Alliances in providing resources on chemoprevention for their regions – ensuring accurate information is provided for patients.
Dr Samuel Smith, author of the report and a Cancer Research UK fellow at the University of Leeds, said: “Our report helps us to understand GP attitudes towards the use of cancer preventing drugs. It’s clear that more needs to be done to promote the evidence and guidance associated with these drugs, particularly as research reveals GPs are lacking the support to discuss effectively the risks and benefits of preventive therapy.”
Professor Arnie Purushotham, Cancer Research UK’s senior clinical adviser, said: “Cancer-preventing drugs have the potential to have a huge impact by reducing the risk of cancer developing in the first place. This report reveals that it’s vital that GPs are given the right support and information so they are confident to explore the value of these drugs with those who would benefit from them, wherever they are in the UK.”
To help raise awareness of NICE guidelines, the Cancer Research UK Facilitator programme is highlighting them in their work with GPs on preventing cancer.
Professor Purushotham added: “While this study focuses on reducing cancer risk, chemoprevention can also be used to reduce the risk of some cancers returning or spreading. It’s essential that the NHS provides a clear steer to doctors to ensure all patients have equal access to treatments that could benefit them.”
The findings looking at tamoxifen awareness are also published in the British Journal of General Practice.
*The report focussed on the prevention of breast and bowel cancer, via the use of tamoxifen and aspirin because of the level of evidence demonstrating the efficacy of both these drugs. It intentionally chose one drug that is covered by national guidance (tamoxifen) and one that is not (aspirin). This is despite there being evidence that aspirin can reduce the risk of certain cancers.
**The study is based on a sample of 1,007 GPs from across the UK.