Improving primary care identification of familial breast cancer risk using proactive invitation and decision support

被引:8
|
作者
Qureshi, Nadeem [1 ]
Dutton, Brittany [1 ]
Weng, Stephen [1 ]
Sheehan, Christina [1 ]
Chorley, Wendy [2 ]
Robertson, John F. R. [3 ]
Kendrick, Denise [1 ]
Kai, Joe [1 ]
机构
[1] Univ Nottingham, NIHR Sch Primary Care Res, Sch Med, Div Primary Care, 13th Floor,Tower Bldg, Nottingham NG7 2RD, England
[2] Univ Hosp Derby & Burton NHS Fdn Trust, Royal Derby Hosp, Derby, England
[3] Univ Nottingham, Sch Med, Nottingham, England
关键词
Primary health care; Breast cancer; Family history; Medical genetics; Decision support; Risk assessment; YOUNG-WOMEN; MANAGEMENT; RECOMMENDATIONS; COMMUNICATION; MAMMOGRAPHY; DIAGNOSIS; HISTORY; BRCA2;
D O I
10.1007/s10689-020-00188-z
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Family history of breast cancer is a key risk factor, accounting for up to 10% of cancers. We evaluated the proactive assessment of familial breast cancer (FBC) risk in primary care. Eligible women (30 to 60 years) were recruited from eight English general practices. Practices were trained on FBC risk assessment. In four randomly-assigned practices, women were invited to complete a validated, postal family history questionnaire, which practice staff inputted into decision support software to determine cancer risk. Those with increased risk were offered specialist referral. Usual care was observed in the other four practices. In intervention practices, 1127/7012 women (16.1%) returned family history questionnaires, comprising 1105 (98%) self-reported white ethnicity and 446 (39.6%) educated to University undergraduate or equivalent qualification, with 119 (10.6%) identified at increased breast cancer risk and offered referral. Sixty-seven (56%) women recommended referral were less than 50 years old. From 66 women attending specialists, 26 (39.4%) were confirmed to have high risk and recommended annual surveillance (40-60 years) and surgical prevention; while 30 (45.5%) were confirmed at moderate risk, with 19 offered annual surveillance (40-50 years). The remaining 10 (15.2%) managed in primary care. None were recommended chemoprevention. In usual care practices, only ten women consulted with concerns about breast cancer family history. This study demonstrated proactive risk assessment in primary care enables accurate identification of women, including many younger women, at increased risk of breast cancer. To improve generalisability across the population, more active methods of engagement need to be explored. Trial registration: CRUK Clinical Trials Database11779.
引用
收藏
页码:13 / 21
页数:9
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