Abstract
In England, the National Institute for Health and Care Excellence guideline for familial breast cancer recommends chemoprevention for women at high and moderate familial risk of breast cancer. However, prescribing of chemoprevention has not improved since the introduction of the guideline in 2013. The study aims to identify the current practice, in England, of familial cancer specialists offering chemoprevention and recommending prescribing in primary care. This was an anonymized national cross-sectional survey of familial breast cancer risk services in England. Lead clinicians were sent an online survey link. The survey questions included whether chemoprevention was offered/considered for high- and moderate-risk women, when chemoprevention prescribing and recommendation to primary care started, medications prescribed, age groups considered for chemoprevention, and existence of a shared prescribing protocol with primary care. The survey was sent to 115 hospital services; responses from 50 services (43%) were included in the analysis. Of the 40 services offering chemoprevention for high-risk women, 15 (38%) did not prescribe but 31 (78%) recommended prescribing to primary care. Of the 31 services considering chemoprevention for moderate risk, eight (26%) did not prescribe with 26 (84%) recommended prescribing to primary care. Only three services reported having a shared protocol with primary care. Within 3 years of the guidelines, many services recognized the role of chemoprevention for both high and moderate risk with a key role for primary care to initiate prescribing. However, there is still room for improvement.
Highlights
Breast cancer is the most common cancer in women worldwide (World Cancer Research Fund 2019)
This study aims to identify which familial cancer services in England recommend chemoprevention for women at high and moderate risk of familial breast cancer in line with the 2013 National Institute for Health and Care Excellence (NICE) guidelines and if they advise primary care to prescribe chemoprevention
Two hundred and seventeen NHS trusts were identified from the NHS directory as of May 2019, of which 109 trusts were identified as potential sites that provide familial breast cancer (FBC) services based on Overall, the questionnaire was sent to 115 services in July– September 2019; 53 responses were received from 51 services
Summary
Breast cancer is the most common cancer in women worldwide (World Cancer Research Fund 2019). NHS Derby and Derbyshire Clinical Commissioning Group, Derby, UK countries, one in eight women will develop breast cancer in their lifetime (Cancer Research UK 2018). History of breast and related cancers is recognized as a risk factor and has been used to stratify disease risk (Cancer Research UK 2018; NICE 2013b). In England, the National Institute for Health and Care Excellence (NICE) categorizes familial breast cancer (FBC) risk into near population risk (lifetime risk < 17% from age 20 and < 3% between ages 40 and 50), moderate risk (lifetime risk of 17–29% from age 20 or 3–8% between ages 40 and 50), and high risk (lifetime risk of ≥ 30% from age 20 or > 8% risk between ages 40 and 50) (NICE 2013b)
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