title: [Referral for mammography often not according to guideline].
abstract: OBJECTIVE
  To analyse the percentage of women with a family history of breast cancer referred by general practitioners (GPs) for a screening mammography in accordance with the Dutch Breast Cancer Guideline produced by the Netherlands Comprehensive Cancer Centre (IKNL).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Women referred by their GP between December 2011 and December 2012 for mammography, with the indication "family history of breast cancer", were invited to take part in this study. A trained radiology laboratory assistant carried out a structured questionnaire to assess their risk on the basis of the categories of the 2008 IKNL guideline "Family history of breast/ovarian cancer". Based on the presence of certain risk factors, the women were allocated to one of the following groups: "referral for mammography", "referral to a clinical geneticist" or "no referral indicated".
  
  
  RESULTS
  242 women were referred by their GPs to the Radiology Department for mammography on the basis of family history; we included 210 women in our study. Their ages ranged from 25 to 77 years (mean age: 48 years). Forty-five patients (21%) were referred for mammography in accordance with the guideline. Twenty-two patients (10%) should have been referred to a clinical geneticist according to the guideline, whereas 143 patients (68%) did not meet the criteria for a screening mammography outside the screening programme.
  
  
  CONCLUSIONS
  In only 21% of patients referred by their GPs for a screening mammography, with "family history" given as the reason, this referral was in accordance with the standard of the Dutch College of General Practitioners (NHG) or the IKNL guideline. Screening outside the breast cancer screening programme was not indicated according to the guideline for the majority of the women. Referral of 10% of the women referred should have been to a clinical geneticist; this figure rises to as many as 20% using the 2012 IKNL guideline.
authors: Gelre Ziekenhuizen, Apeldoorn.
authors: Dalith
authors: D
authors: Lodder-van der Vlies
authors: Kitty  E
authors: K
authors: Droogh-de Greve
authors: Jos L M
authors: JL
authors: de Win
authors: Hester J
authors: HJ
authors: van der Zaag-Loonen
authors: J A Rykel
authors: JA
authors: van Bruggen
authors: Hetty P
authors: HP
authors: Markestein
authors: Jan Willem C
authors: JW
authors: Gratama
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D058006:General Practice / Q000592:standards*; D006801:Humans; D008327:Mammography / Q000592:standards*; D008403:Mass Screening / Q000592:standards; D008875:Middle Aged; D009426:Netherlands; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors