Transitioning to routine breast cancer risk assessment and management in primary care: what can we learn from cardiovascular disease?Kelly-Anne Phillips A B C , Emma J. Steel A D , Ian Collins A , Jon Emery E , Marie Pirotta E , G. Bruce Mann F , Phyllis Butow G , John L. Hopper B H , Alison Trainer A , Jane Moreton A , Antonis C. Antoniou I , Jack Cuzick J and Louise Keogh D K
A Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, East Melbourne, Vic. 8006, Australia.
B Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia.
C Department of Medicine, St Vincent’s Hospital, 29 Regent Street, Fitzroy, Vic. 3065, Australia.
D Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia.
E General Practice and Primary Care Academic Centre, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia.
F The Breast Service, Royal Melbourne and Royal Women’s Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia.
G Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Transient Building F12, Darlington, NSW 2006, Australia.
H School of Public Health, Seoul National University, 1 Gwanek-ro, Gwanek-gu, Seoul 151-742, Korea.
I Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, United Kingdom.
J Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, United Kingdom.
K Corresponding author. Email: email@example.com
Australian Journal of Primary Health 22(3) 255-261 https://doi.org/10.1071/PY14156
Submitted: 23 October 2014 Accepted: 20 December 2014 Published: 24 February 2015
To capitalise on advances in breast cancer prevention, all women would need to have their breast cancer risk formally assessed. With ~85% of Australians attending primary care clinics at least once a year, primary care is an opportune location for formal breast cancer risk assessment and management. This study assessed the current practice and needs of primary care clinicians regarding assessment and management of breast cancer risk. Two facilitated focus group discussions were held with 17 primary care clinicians (12 GPs and 5 practice nurses (PNs)) as part of a larger needs assessment. Primary care clinicians viewed assessment and management of cardiovascular risk as an intrinsic, expected part of their role, often triggered by practice software prompts and facilitated by use of an online tool. Conversely, assessment of breast cancer risk was not routine and was generally patient- (not clinician-) initiated, and risk management (apart from routine screening) was considered outside the primary care domain. Clinicians suggested that routine assessment and management of breast cancer risk might be achieved if it were widely endorsed as within the remit of primary care and supported by an online risk-assessment and decision aid tool that was integrated into primary care software. This study identified several key issues that would need to be addressed to facilitate the transition to routine assessment and management of breast cancer risk in primary care, based largely on the model used for cardiovascular disease.
Additional keywords: decision support, risk management, screening, tamoxifen.
ReferencesAmir E, Freedman OC, Seruga B, Evans DG (2010) Assessing women at high risk of breast cancer: a review of risk assessment models. Journal of the National Cancer Institute 102, 680–691.
| Assessing women at high risk of breast cancer: a review of risk assessment models.CrossRef | 20427433PubMed |
Australian Institute of Health and Welfare (2010) Incidence of cancer. In ‘Cancer in Australia 2010: an overview’. AIHW cat. no. CAN 56. pp. 10–19. AIHW, Canberra.
Bonner C, Jansen J, McKinn S, Irwig L, Doust J, Glasziou P, Hayen A, McCaffery K (2013) General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study. The Medical Journal of Australia 199, 485–489.
| General practitioners’ use of different cardiovascular risk assessment strategies: a qualitative study.CrossRef | 24099210PubMed |
Britt H, Miller GC, Henderson J, Bayram C, Valenti L, Harrison C, Charles J, Pan Y, Zhang C, Pollack AJ, O’Halloran J (2013) ‘General practice activity in Australia 2012–13.’ (Sydney University Press: Sydney)
Campbell SM, Roland MO, Middleton E, Reeves D (2005) Improvements in quality of clinical care in English general practice 1998–2003: longitudinal observational study. British Medical Journal 331, 1121–1123.
| Improvements in quality of clinical care in English general practice 1998–2003: longitudinal observational study.CrossRef | 16257992PubMed |
Collins IM, Steel E, Mann GB, Emery JD, Bickerstaffe A, Trainer A, Butow P, Pirotta M, Antoniou AC, Cuzick J, Hopper J, Phillips K-A, Keogh LA (2014) Assessing and managing breast cancer risk: clinicians’ current practice and future needs. The Breast 23, 644–650.
| Assessing and managing breast cancer risk: clinicians’ current practice and future needs.CrossRef | 24998452PubMed |
Department of General Practice (2006) Victorian Primary Care Practice-Based Research Network. (The University of Melbourne: Melbourne) Available at http://www.gp.unimelb.edu.au/vicren/ [Verified 6 August 2012]
Evans DGR, Warwick J, Astley SM, Stavrinos P, Sahin S, Ingham S, McBurney H, Eckersley B, Harvie M, Wilson M, Beetles U, Warren R, Hufton A, Sergeant JC, Newman WG, Buchan I, Cuzick J, Howell A (2012) Assessing individual breast cancer risk within the U.K. National Health Service breast screening program: a new paradigm for cancer prevention. Cancer Prevention Research (Philadelphia, Pa.) 5, 943–951.
| Assessing individual breast cancer risk within the U.K. National Health Service breast screening program: a new paradigm for cancer prevention.CrossRef |
Harvey SL, Francis JE, McBride AJ, Bishop JF, Phillips K-A (2011) Medication to prevent breast cancer – too much to swallow? The Medical Journal of Australia 195, 646–649.
| Medication to prevent breast cancer – too much to swallow?CrossRef | 22171850PubMed |
Hopper JL (2011) Disease-specific prospective family study cohorts enriched for familial risk. Epidemiologic Perspectives & Innovations 8, 2–10.
| Disease-specific prospective family study cohorts enriched for familial risk.CrossRef |
National Breast and Ovarian Cancer Centre (2009) ‘Breast cancer risk factors: a review of the evidence.’ (National Breast and Ovarian Cancer Centre: Sydney)
National Breast and Ovarian Cancer Centre (2010) Advice about familial aspects of breast cancer and epithelial ovarian cancer: a guide for health professionals. (NBOCC: Sydney) Available at http://canceraustralia.gov.au/sites/default/files/publications/nbocc-bog-2010-web-a4-printable_504af02a673fd.pdf [Verified 20 May 2014]
Nelson MR, Doust JA (2013) Primary prevention of cardiovascular disease: new guidelines, technologies and therapies. The Medical Journal of Australia 198, 606–610.
| Primary prevention of cardiovascular disease: new guidelines, technologies and therapies.CrossRef | 23919708PubMed |
Nouwens E, Van Lieshout J, Adang E, Bouma M, Braspenning J, Wensing M (2012) Effectiveness and efficiency of a practice accreditation program on cardiovascular risk management in primary care: study protocol of a clustered randomized trial. Implementation Science; IS 7, 94–101.
| Effectiveness and efficiency of a practice accreditation program on cardiovascular risk management in primary care: study protocol of a clustered randomized trial.CrossRef | 23035760PubMed |
Peiris DP, Joshi R, Webster RJ, Groenestein P, Usherwood TP, Heeley E, Turnbull FM, Lipman A, Patel AA (2009) An electronic clinical decision support tool to assist primary care providers in cardiovascular disease risk management: development and mixed methods evaluation. Journal of Medical Internet Research 11, e51
| An electronic clinical decision support tool to assist primary care providers in cardiovascular disease risk management: development and mixed methods evaluation.CrossRef | 20018588PubMed |
Royal Australian College of General Practitioners (2012) Early detection of cancers. In ‘Guidelines for preventive activities in general practice’. pp. 65–67. RACGP, Melbourne.
Wuttke M, Phillips KA (2015) Clinical management of women at high risk of breast cancer. Current Opinion in Obstetrics and Gynecology 27, 6–13.