Abstract
BackgroundUp to 65% of newly diagnosed breast cancer patients had not been screened correctly before diagnosis resulting in increased stage of cancer at presentation. This study assessed whether their primary relatives are, in turn, assessed appropriately.MethodsAn ethically approved prospective study involving 274 primary relatives of women diagnosed with breast cancer, between 2009–2012, at a symptomatic breast unit in Ireland. Telephone interview established: demographics, menstrual history, family history verification, breast screening history. Personal risk level was calculated and whether current screening met screening guidelines. Participants were enrolled into appropriate screening programs if currently not in one and results analyzed.ResultsTwo hundred and fifteen of the 280 (76.8%) newly diagnosed patients responded giving details of their 274 primary relatives; this made up the study cohort. Mean age 50 ± 10 (35–75). Thirty two percent were low risk, 64% moderate and 4% high. 190/274 (69%) were being screened appropriately. Seventy five relatives were then assessed with: mammography in 55, Mg and US in 16. Four underwent a biopsy and to date none had cancer. Surveillance was: annual screening in 48%; national screening program and General Practitioner (GP) in 33%; GP only in over 65s in 13%; 6% await further assessment at specialist genetics clinics where their surveillance will be decided.ConclusionsThis study has identified an opportunity to improve the delivery of appropriate screening to higher risk primary relatives of patients with breast cancer. This necessitates an integrated national approach involving providers of primary care, patients and screening breast programs.
Highlights
Up to 65% of newly diagnosed breast cancer patients had not been screened correctly before diagnosis resulting in increased stage of cancer at presentation
This study has identified an opportunity to improve the delivery of appropriate screening to higher risk primary relatives of patients with breast cancer
While there are opponents of breast screening, concerned mainly regarding over diagnosis in DCIS, we have identified in our region that women meeting breast screening or family history risk criteria who were not appropriately screened with mammography presented with more significant advanced stages of breast cancer (Johnston et al 2015)
Summary
Up to 65% of newly diagnosed breast cancer patients had not been screened correctly before diagnosis resulting in increased stage of cancer at presentation. This study assessed whether their primary relatives are, in turn, assessed appropriately. Governments globally have advocated screening for certain common cancers, in particular breast and bowel cancer, to allow earlier detection and improve outcome. This process has been tailored to those in the highest risk age group; usually in the 50–70 year olds. This screening is costly and discussions regarding over diagnosis are common (Rashidian et al 2013; Arrospide et al 2016; Rafia et al 2016; Swain et al 2016).
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