Tamoxifen citrate - Breast cancer - chemoprevention

The Surrey & Sussex APC agreed a change from Blue (with specialist initiation) to Blue (on specialist reccomendation) for patients requiring anastrozole, tamoxifen or raloxifen for breast cancer risk reduction.

This change aligns the Surrey recommendation with Sussex and supersedes the previous Surrey recommendation described below.

The Surrey Heartlands Integrated Care System Area Prescribing Committee have agreed a formulary status for tamoxifen, anastrozole and raloxifene for chemoprevention in women at moderate or high risk of developing breast cancer for a duration of 5 years.

A BLUE (with specialist initiation) with 1 month prescribing by the specialist team following discussions with the patient about the risks and benefits of treatment.

Tamoxifen can be used:

• Premenopausal except in those with past history or may be at increased risk of thromboembolic disease or endometrial cancer
• Postmenopausal who have severe osteoporosis or do not wish to take anastrozole if no past history or increased risk of thromboembolic disease or endometrial cancer

On occasion a patient may need time to consider treatment and may in those circumstances request that their GP prescribe. The GP will then need to consider if they have all the information from the specialist team in order to accept full clinical responsibility for prescribing for that patient.