title: Transitioning to routine breast cancer risk assessment and management in primary care: what can we learn from cardiovascular disease?
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.
authors.affiliation: Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, East Melbourne, Vic. 8006, Australia.
authors.forename: Kelly-Anne
authors.initials: KA
authors.lastname: Phillips
authors.affiliation: Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, East Melbourne, Vic. 8006, Australia.
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Steel
authors.affiliation: Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, East Melbourne, Vic. 8006, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Collins
authors.affiliation: General Practice and Primary Care Academic Centre, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Emery
authors.affiliation: General Practice and Primary Care Academic Centre, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Pirotta
authors.affiliation: The Breast Service, Royal Melbourne and Royal Women's Hospital, 20 Flemington Road, Parkville, Vic. 3052, Australia.
authors.forename: G Bruce
authors.initials: GB
authors.lastname: Mann
authors.affiliation: Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Transient Building F12, Darlington, NSW 2006, Australia.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Butow
authors.affiliation: 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.
authors.forename: John L
authors.initials: JL
authors.lastname: Hopper
authors.affiliation: Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, East Melbourne, Vic. 8006, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Trainer
authors.affiliation: Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, East Melbourne, Vic. 8006, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Moreton
authors.affiliation: Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Worts Causeway, Cambridge, CB1 8RN, United Kingdom.
authors.forename: Antonis C
authors.initials: AC
authors.lastname: Antoniou
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, United Kingdom.
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.affiliation: Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3010, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Keogh
mesh_terms: D000328:Adult; D001315:Australia; D001943:Breast Neoplasms / Q000517:prevention & control*; D002318:Cardiovascular Diseases / Q000517:prevention & control; D005260:Female; D017144:Focus Groups; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D018570:Risk Assessment