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Impact of NICE guidance on tamoxifen prescribing in England 2011–2017: an interrupted time series analysis

British Journal of Cancervolume 118pages12681275 (2018) | Download Citation



Tamoxifen was recommended by NICE in 2013 for chemoprevention of breast cancer, but a recent survey suggested only a quarter of GPs are aware of this. We set out to measure the uptake of tamoxifen, and the alternative raloxifene, in national prescribing data sets.


Tamoxifen and raloxifene data were extracted from England’s monthly prescribing data sets, October 2010–October 2017. We used interrupted time series analysis to reveal national and local responses to guidelines. We investigated variation between practices by calculating percentiles for prescribing rates and ratios of change.


We found an increase in monthly tamoxifen prescribing following release of the guidelines, with an increase in gradient (p = 0.001) but no step change (p = 0.342). Alongside a small change in raloxifene prescribing we estimate 8450 women took up chemoprevention between 2013 and 2016. We did not find evidence that this was limited to a small group of practices.


Our results suggest that the uptake of new guidance on chemoprevention has been slow and has potentially left women exposed to avoidable risk. Improving dissemination of guidance to healthcare professionals and routinely monitoring implementation could help reduce this risk.

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We are grateful to Seb Bacon for obtaining the data and Richard Croker for pharmaceutical advice. B.G. has received funding from the Health Foundation, the National Institute for Health Research School of Primary Care Research, the NIHR Biomedical Research Centre Oxford, the West of England Academic Health Sciences Network and NHS England for work on UK prescribing data.

Author contributions

H.C. conceived the project, designed the methods, wrote the paper and interpreted the findings, with input from B.G. H.C. extracted and processed the data in SQL and Excel. A.W. conducted the analysis in Stata. B.G. obtained funding and supervised the project. All authors contributed to and approved the final manuscript.

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  1. Evidence Based Medicine DataLab, Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom

    • Helen J. Curtis
    • , Alex J. Walker
    •  & Ben Goldacre


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Competing interest

B.G has received funding from the Health Foundation, the National Institute for Health Research School of Primary Care Research, the NIHR Biomedical Research Centre Oxford, the West of England Academic Health Sciences Network and NHS England for work on UK prescribing data. H.C. and A.W. are employed on these grants. B.G. has additionally received funding from the Laura and John Arnold Foundation, the Wellcome Trust, and the World Health Organisation to work on better use of data in medicine; and receives personal income from speaking and writing for lay audiences on the misuse of science.

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Correspondence to Ben Goldacre.

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