Transitioning to routine breast cancer risk assessment and management in primary care: What can we learn from cardiovascular disease?

Citation

Phillips K, Steel E, Collins I, Emery J, Pirotta M, Mann GB, Butow P, Hopper JL, Trainer A, Moreton J, Antoniou AC, Cuzick J & Keogh L (2015) Transitioning to routine breast cancer risk assessment and management in primary care: What can we learn from cardiovascular disease?. Australian Journal of Primary Health, 22 (3), pp. 255-261. https://doi.org/10.1071/PY14156

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.

Keywords
decision support; risk management; screening; tamoxifen

Journal
Australian Journal of Primary Health: Volume 22, Issue 3