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 KA 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: l.keogh@unimelb.edu.au
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
Abstract
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.
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