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Qureshi N, Dutton B, Weng S, Sheehan C, Chorley W, Robertson JFR, Kendrick D, Kai J. Improving primary care identification of familial breast cancer risk using proactive invitation and decision support. Fam Cancer 2020; 20:13-21. [PMID: 32524330 PMCID: PMC7870768 DOI: 10.1007/s10689-020-00188-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/18/2020] [Indexed: 01/28/2023]
Abstract
Family history of breast cancer is a key risk factor, accounting for up to 10% of cancers. We evaluated the proactive assessment of familial breast cancer (FBC) risk in primary care. Eligible women (30 to 60 years) were recruited from eight English general practices. Practices were trained on FBC risk assessment. In four randomly-assigned practices, women were invited to complete a validated, postal family history questionnaire, which practice staff inputted into decision support software to determine cancer risk. Those with increased risk were offered specialist referral. Usual care was observed in the other four practices. In intervention practices, 1127/7012 women (16.1%) returned family history questionnaires, comprising 1105 (98%) self-reported white ethnicity and 446 (39.6%) educated to University undergraduate or equivalent qualification, with 119 (10.6%) identified at increased breast cancer risk and offered referral. Sixty-seven (56%) women recommended referral were less than 50 years old. From 66 women attending specialists, 26 (39.4%) were confirmed to have high risk and recommended annual surveillance (40–60 years) and surgical prevention; while 30 (45.5%) were confirmed at moderate risk, with 19 offered annual surveillance (40–50 years). The remaining 10 (15.2%) managed in primary care. None were recommended chemoprevention. In usual care practices, only ten women consulted with concerns about breast cancer family history. This study demonstrated proactive risk assessment in primary care enables accurate identification of women, including many younger women, at increased risk of breast cancer. To improve generalisability across the population, more active methods of engagement need to be explored. Trial registration: CRUK Clinical Trials Database 11779.
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Affiliation(s)
- Nadeem Qureshi
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK.
| | - Brittany Dutton
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Stephen Weng
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Christina Sheehan
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Wendy Chorley
- University Hospitals Derby & Burton NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | | | - Denise Kendrick
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
| | - Joe Kai
- Division of Primary Care, NIHR School for Primary Care Research, School of Medicine, University of Nottingham, 13th Floor, Tower Building, Nottingham, NG7 2RD, UK
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Copeland R, Chorley W, Hurst N. Review of family history taking in women aged under fifty years presenting with colorectal cancer. Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ledlie N, Chorley W, Hurst N. Audit of subjects with family history of colorectal cancer attending a familial cancer service. J Med Screen 2008; 15:211-2. [PMID: 19106263 DOI: 10.1258/jms.2008.008082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ellis D, Greenman J, Hodgson S, McCall S, Lalloo F, Cameron J, Izatt L, Scott G, Jacobs C, Watts S, Chorley W, Perrett C, Macdermot K, Mohammed S, Evans G, Mathew CG. Low prevalence of germline BRCA1 mutations in early onset breast cancer without a family history. J Med Genet 2000; 37:792-4. [PMID: 11183185 PMCID: PMC1757159 DOI: 10.1136/jmg.37.10.792] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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