Jack Cusick gave us 16 year results; it looks as if Tamoxifen is a very powerful drug for cancer prevention. What did you make about his presentation on the use of Tamoxifen to prevent breast cancer?

We’ve known for a while that Tamoxifen works in cancer prevention. Again, it doesn’t impact on survival and, as he more than clearly alluded to, there’s perhaps an exaggerated perception that Tamoxifen is too toxic. This adds to a body of data of other studies showing that Tamoxifen is preventive and also that aromatase inhibitors can be preventive in this setting. It’s interesting to see that the effect carries over the more you follow these patients, again, and suggests the possibility that even shorter treatments could be also effective although he admitted that those studies will be very difficult to do i.e. two versus five years.

How do you think the difficulty of persuading women to use this preventive strategy can be tackled?

We need to do what we did today – keep informing the public about the benefits of it; keep informing the doctors, try to change the perception that this is more toxic than beneficial. It’s very clear that some cancers still occur; I don’t think Tamoxifen is causing any cancers, so we just need to keep talking about this and maybe the public will change its mind.

On the other hand, on the other hand we’re at a point at which we can detect early cancers and when we detect them early most of them are curable so maybe that is, in a way, reassuring the public that if I don’t take it I can always pick it up early by the yearly mammograms and exams and still take care of it. But for women at high risk, again, Tamoxifen should be considered and that high risk is going to be increasingly defined over the next few years with genomic studies. We’re going to try to understand better what are the women where we really need to consider this based on genomic data.