General Practitioners and Breast Surgeons in France, Germany, Netherlands and the UK show variable breast cancer risk communication profiles

Claire Julian-Reynier,Joerg Schmidtke,D Gareth Evans,Aad Tibben,Irmgard Nippert,Anne-Deborah Bouhnik,Hilary Harris,Christi J Van Asperen

doi:10.1186/s12885-015-1281-2

Abstract

BackgroundNo information is available on the attitudes of General Practitioners (GPs) and Breast Surgeons (BSs) to their delivery of genetic, environmental and lifestyle risk factor information about breast cancer. The aim of this study was to describe the Breast Cancer Risk Communication Behaviours (RCBs) reported by GPs and BSs in four European countries and to determine the relationships between their RCBs and their socio-occupational characteristics.MethodsSelf-administered questionnaires assessing breast cancer risk communication behaviours using vignettes were mailed to a sample of Breast Surgeons (BS) and General Practitioners (GP) working in France, Germany, the Netherlands, and the UK (N = 7292). Their responses to questions about the risk factors were first ordered and compared by specialty and country after making multivariate adjustments. Rather than defining a standard Risk Presentation Format (RPF) a priori, the various RPFs used by the respondents were analyzed using cluster analysis.ResultsFamily history and hormonal replacement therapy were the risk factors most frequently mentioned by the 2094 respondents included in this study. Lifestyle BC risk factors such as obesity and alcohol were rarely/occasionally mentioned, but this point differed (p < 0.001) depending on the country and the specialty of the providers involved. Five distinct RPF profiles including the numerical/verbal presentation of absolute/relative risks were identified. The most frequently encountered RPF (34.2%) was characterized by the fact that it included no negative framing of the risks, i.e., the probability of not developing cancer was not mentioned. Age, specialty and country of practice were all found to be significant determinants of the RPF clusters.ConclusionsThe increasing trend for GPs and BSs to discuss lifestyle risk factors with their patients suggests that this may be a relevant means of improving breast cancer prevention. Physicians’ risk communication skills should be improved during their initial and vocational training.

Highlights

No information is available on the attitudes of General Practitioners (GPs) and Breast Surgeons (BSs) to their delivery of genetic, environmental and lifestyle risk factor information about breast cancer
It has been clearly established that lifetime exposure to genetic, environmental and lifestyle risk factors play an important role in the aetiology of this disease
7 GPs and 22 Breast Surgeons were excluded from the analysis because they declared that they had not been consulted by any breast cancer patients during the previous year

Summary

Introduction

No information is available on the attitudes of General Practitioners (GPs) and Breast Surgeons (BSs) to their delivery of genetic, environmental and lifestyle risk factor information about breast cancer. Convincing or at least strong evidence has Julian-Reynier et al BMC Cancer (2015) 15:243 and a high energy intake (obesity after menopause or weight gain after 18 years of age), have been found to contribute significantly to the occurrence of breast cancer, whereas smoking is a risk factor on which more evidence is required [1,2,3]. Interactions between these factors have been described, especially in BRCA1/2 mutation carriers [5]. One of the key issues which needs to be addressed by healthcare providers is how to communicate information about patients’ genetic/family risks and other significant changeable risk factors for preventive purposes

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