Assessing breast cancer risk in primary care: What can we learn from cardiovascular disease?

Abstract

17 Background: Routine assessment of breast cancer (BC) risk by primary care clinicians (PCCs) might improve uptake of (BC) prevention and screening interventions and thus reduce morbidity and mortality. Methods: Australian PCCs were recruited through local professional networks. Facilitated focus group discussions about current practice of assessing and managing BC risk were audiotaped, transcribed verbatim and managed using QSR NVivo qualitative data management software. A coding framework was developed based on the transcripts, data was coded and each code further analyzed to identify key themes. Results: 17 PCCs (12 doctors, 5 practice nurses) participated in 2 focus groups. 41% were male, median age 49 years, median number of years as a PCC was 15. Approaches to assessment and management of BC risk differed markedly from that of cardiovascular (CV) risk. PCCs see assessment and management of CV risk as an intrinsic, expected part of their role. Sidebar prompts on practice software trigger CV risk assessment and PCCs often use an online tool (www.knowyournumbers.co.nz) to provide personalized risk estimates and to discuss management options for CV risk. Conversely, assessment of BC risk is haphazard, generally patient (not clinician) initiated, and management, beyond routine BC screening (e.g. chemoprevention), is considered outside the domain of the PCC. BC risk assessment is not prompted by practice software. Most PCCs are not familiar with, or using, BC risk assessment tools. PCCs suggested they could potentially routinely assess and manage BC risk, but such an approach would need to be widely endorsed as within the remit of primary care and would be enhanced by an online tool that is accessible, quick, visual (graphs and pictograms), evidence-based and regularly updated. Ideally, its use would be prompted by their practice software. Conclusions: There is a clear opportunity in primary care to enhance the capacity and motivation of clinicians to assess and manage BC risk. A risk assessment and decision aid tool, integrated into primary care software, might facilitate routine appropriate management of BC risk in the Australian primary care setting, modelling what has already been achieved for CV disease.