Raising concerns about family history of breast cancer in primary care consultations: prospective, population based study
In consultation with their general practitioners and practice nurses, women raise the issue of a family history of breast cancer relatively infrequently, report the Women's Concerns Study Group in this week's BMJ.
Following the availability of genetic tests for breast cancer, genetic centres have reported increasing referral, often of women who are at low risk by current knowledge, but who are concerned about the implications of their family history.
To inform better management in primary care, all primary care consultations between women (16 years and over) and doctors and nurses (clinicians) in 18 practices were counted over 4 week periods between August 1997 and July 1998. Mention of a family history of breast cancer was recorded in less than 4% of consultations. Clinicians were 6.6 times more likely to raise the issue than women. For each 1000 women on the practice list about 15 a year will raise the issue of a family history of breast cancer. Almost 10 times that number (141) consult for contraceptive advice, and three times that number for menstrual disorders.
Primary care teams might best manage the relatively few women consulting with specific concerns about family history of breast cancer, by referral within the team to a member trained in genetic counselling, possibly with computer support.
Professor Ann Louise Kinmonth, General Practice and Primary Care Research Unit, University of Cambridge, UK Email:firstname.lastname@example.org