title: Improving the management of people with a family history of breast cancer in primary care: before and after study of audit-based education.
abstract: BACKGROUND
  In England, guidance from National Institute for Clinical Excellence (NICE) states women with a family history of breast cancer presenting to primary care should be reassured or referred.We reviewed the evidence for interventions that might be applied in primary care and conducted an audit of whether low risk women are correctly advised and flagged.
  
  
  METHODS
  We conducted a literature review to identify modifiable risk factors. We extracted routinely collected data from the computerised medical record systems of 6 general practices (population approximately 30,000); of the variables identified in the guidance. We implemented a quality improvement (QI) intervention called audit-based education (ABE) comparing participant practices with guidelines and each other before and after; we report odds ratios (OR) of any change in data recording.
  
  
  RESULTS
  The review revealed evidence for advising on: diet, weight control, physical exercise, and alcohol. The proportion of patients with recordings of family history of: disease, neoplasms, and breast cancer were: 39.3%, 5.1% and 1.3% respectively. There was no significant change in the recording of family history of disease or cancer; OR 1.02 (95% CI 0.98-1.06); and 1.08 (95% CI 0.99-1.17) respectively. Recording of alcohol consumption and smoking both increased significantly; OR 1.36 (95% CI 1.30-1.43); and 1.42 (95% CI 1.27-1.60) respectively. Recording lifestyle advice fell; OR 0.84 (95% CI 0.81-0.88).
  
  
  CONCLUSIONS
  The study informs about current data recording and willingness to engage in ABE. Recording of risk factors improved after the intervention. Further QI is needed to achieve adherence to current guidance.
authors.affiliation: Division of Population Health Sciences and Education, St George’s, University of London, Cranmer Terrace, London SW17 0RE, UK.
authors.forename: Imran
authors.initials: I
authors.lastname: Rafi
authors.forename: Susmita
authors.initials: S
authors.lastname: Chowdhury
authors.forename: Tom
authors.initials: T
authors.lastname: Chan
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Jubber
authors.forename: Mohammad
authors.initials: M
authors.lastname: Tahir
authors.forename: Simon
authors.initials: S
authors.lastname: de Lusignan
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control*; D004739:England; D055317:Evidence-Based Practice; D005194:Family Practice / Q000193:education / Q000592:standards*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008487:Medical History Taking; D008875:Middle Aged; D016017:Odds Ratio; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods; D012017:Referral and Consultation; D012196:Review Literature as Topic; D012307:Risk Factors