Table 4.

Perceptions of Modality-Specific Regimen, Possible Side Effects and Effectiveness

Modality-Specific Factors of Willingness to Use Chemopreventive Agents
Modality	Perceptions of Regimen	Perceptions of Side Effects	Perceptions of Effectiveness
Pill (for breast/ovarian cancers)	- Noted ease and convenience of being able to fit into and/or combine with existing daily routines (e.g., brushing teeth, taking birth control pill) - Expressed uncertainty in their ability to carry out a daily pill regimen for 5 years - Concerned about impact of missing a dose	- Expressed most concern for increased risk of uterine cancer and blood clots – perceived as too serious for preventive purposes	- Considered pills not as effective as modalities that delivered medicine directly to the organ(s) of concern - Perceived risk-reduction activities, such as diet and exercise, to be more effective
Topical Agent – Gel/Cream (for all cancers)	- Perceived as easy and convenient - Expressed confidence in being able to fit it into their existing daily routines (e.g., beauty/skin care regimen) indefinitely - Preferred regimen that didn’t require application outside the home - Wanted to know more about the application process, such as whether they could take a shower after applying or if re-application would be necessary after exercise or sweating	- Concerned about the severity and duration of the irritated skin and rash - Worried about an unpleasant application process or impact on their skin (e.g., messy application process, leaves a sticky residue, dries out their skin, skin smells during/after application, stains clothing) - Noted that sensitivity to light was not a problem as long as they could still enjoy activities outside - Concerned for others that may come in contact with topical agent (e.g., intimate encounters with partner, child sleeping on their chest)	- Skeptical of how a gel/cream could be effective at preventing cancer without serious side effects, such as interfering with hormones
Topical Agent – Mouthwash (for head/neck/oral cancers)	- Perceived as simple and convenient - Cited ease in being able to fit into and/or combine with existing daily routines (e.g., brushing teeth) - Expressed confidence in being able to adhere to regimen indefinitely - Felt that swishing and/or rinsing was less invasive than swallowing	-Worried about how the rash would impact their ability to breathe, communicate, and eat - Apprehensive about taste (e.g., leaves a bad taste in mouth, gag reflex effect) - Concerned about the severity and duration of the irritated skin or rash, and if it would have a “domino effect” leading to sores or blisters, and possibly infections	- Skeptical of how a mouthwash could be effective at preventing cancer
Hormonal Implant or Ring (for gynecologic cancers)	- Unwillingness stemmed from negative experiences with birth control (e.g., intrauterine device, vaginal ring) - Concerned about invasive nature of the modality, citing their fear of having a foreign object inside their body - Expressed comfort in having a doctor involved to properly insert the device - Apprehensive about taking the power and/or control out of their hands	- Concerned about increasing side effects already experienced through menstruation, birth control, or other gynecologic conditions (e.g., PCOS) - Disliked the possibility of weight gain - Alarmed about the possibility of ovarian cysts and hormones’ impact on fertility, pregnancy, and breastfeeding	- Considered more effective because a healthcare provider inserts the device
Aerosolized Drug (for lung cancer)	- Felt comfortable using due to prior experience and/or familiarity with an inhaler (e.g., asthma, allergies) - Noted the convenience factor of being able to carry it with you - Hesitant (more so average-risk participants) to carry small aerosolized drug device - Preferred frequency of use varied greatly - High-risk participants expressed willingness to increase frequency of use for a shorter duration of time (e.g., daily use for 30 days) or indefinite use	- Perceived to have fewer side effects (compared to a pill) - Concerned about severity and duration of cough (e.g., impact on sleeping, interference at work) - Some high-risk participants familiar with coughing due to smoking and COPD were worried about increased coughing - Other participants were unconcerned and considered it mild in the context of cancer	- Considered more effective due to local delivery and minimal impact on other organ systems
Light Stimulation Therapy (for head/neck/oral cancers)	- Liked the convenience of a one-time treatment - Concerned about accessibility to a clinic - Expressed comfort in knowing a healthcare provider would be involved - Unconcerned about need to take a pill along with the light therapy - Wanted to know more about the regimen (e.g., length of session) and type of light being used	- Concerned about “long laundry list” of possible side effects - Alarmed about possible burning and/or scarring (especially to their face) - Frightened by shortness of breath and trouble swallowing - Some interpreted side effects to be specific to their eyes (e.g., burning, irritation, itching) and worried about eyesight - Worried about light sensitivity impacting their ability to be outdoors - Found side effects to be similar to cancer treatment	- Wanted to see tangible evidence of effectiveness
Prophylactic Surgery	- Viewed as a “last resort” - Needed to be at high risk in order to consider	- Concerned about surgical complications and recovery time - Expressed hesitation (especially 30–45 year olds) due to desire to have children and breastfeed - Worried about impact on hormones and sexual pleasure - Noted emotional impact of a mastectomy, but found benefit in being able to consider reconstructive surgery	- Expected significant reduction and/or elimination of cancer