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GPs should not be expected to initiate cancer prevention drugs, says report

GPs should be offered more support from specialist colleagues to prescribe drugs that can reduce the risk of breast or bowel cancer, authors of a Cancer Research UK report have concluded.

The report found that GPs would be more comfortable prescribing tamoxifen for breast cancer prevention if the drug was initiated by a specialist, while they needed more information and guidance on prescribing aspirin to prevent bowel cancer.

NICE recommended preventive use of tamoxifen – or another similar drug, raloxifene – in women with a clear history of breast cancer in 2013. However, the drugs are not licensed for primary prevention and can also increase the risk of other serious complications so the decision to start treatment can be complicated, experts said.

The team, led by Dr Samuel Smith, Cancer Research UK fellow at the University of Leeds, surveyed over 1,000 GPs in England, Wales and Northern Ireland. The researchers excluding GPs from Scotland, where a national care pathway has already been agreed for tamoxifen prescribing.

They found just over half of the GPs knew that tamoxifen can be used for prevention of breast cancer in women with a clear family history.

But 77% said they would be willing to prescribe tamoxifen and, overall, GPs were 40% more likely to prescribe the drug if asked to continue a prescription initiated in secondary care.

Reporting these survey findings in a paper in the British Journal of General Practice, the team concluded that ’developing a pathway involving both primary and scecondary care in a shared care agreement could substantially increase GPs’ willingness to prescribe’.

In a separate study on GPs’ attitudes to prescribing aspirin for prevention of bowel cancer in people with Lynch Syndrome – which predisposes affected people to bowel cancer – the authors found most GPs would be happy to prescribe aspirin, if provided with more support and information on the benefits of treatment and the correct dosing. 

The Cancer Research UK report called for cancer teams and NICE to develop ‘standardised pro-formas for secondary care clinicians, such as those from the breast cancer department, family history or clinical genetics clinic, to send to GPs when they are referring high-risk patients to discuss chemoprevention’.

Dr Smith said: ‘Our report helps us to understand GP attitudes towards the use of cancer prevention 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.’

RCGP chair Dr Helen Stokes-Lampard said: ‘The benefits of using long term medication to lower the risk of developing cancer are becoming clearer as new research findings become available – and it’s important that this informs official clinical guidelines, and that GPs and our teams are aware of them.

‘But with clinical guidelines rightly being updated so frequently and given the incredibly broad spectrum of knowledge GPs need to have, it’s understandable that family doctors often take cues from our specialist colleagues in hospitals – so improved communication channels between primary and secondary care would certainly be helpful.’