Are Family Doctors Compliant with Breast Family History Guidelines?

Joe Thomas, Michael Sugrue, Sharon Curran, Michelle Furey, Ryan Sugrue

Donegal Clinical and Research Academy, Breast Centre North West Letterkenny Hospital, Donegal, Ireland.
National University of Ireland Galway, University Road, Galway, Ireland.

DOI: 10.4236/abcr.2013.24024                

Abstract

Introduction: Optimizing breast cancer care involves accurate risk assessment. Referrals to secondary care need to be appropriate both in terms of healthcare resource utilisation and the reduction of unnecessary patient anxiety. Aim: This study undertook an evaluation of family doctors compliance with NICE guidelines for asymptomatic family history referrals to a breast unit. Methods: A retrospective audit of general practice in County Donegal was carried out between January 2010 and May 2011. NICE guidelines and IBIS computerised model were used to assess whether referrals were appropriate. Results: 77.6% (90/116) met a criterion for secondary care referral. 51.7% (60/116) met the NICE criteria and 64.7% (75/116) met the IBIS criteria for referral to secondary care. 38.8% (45/116) met both. 6 were of low risk, 45 were of moderate risk and 1 was of high risk. 80.4% (45/56) of the patients who did not meet the NICE criteria, failed to do so because they had one 1^st degree relative with breast cancer who was over the age of 40. Conclusion: 77.6% of referrals complied with international criteria for referral to secondary care. A greater understanding of what constitutes appropriate referral of 1^st degree relatives would enhance the referral process.

Keywords

Referral Guidelines; Family History; Breast Cancer; Risk Assessment

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. Lucassen, E. Watson, J. Harcourt, P. Rose and J. O’Grady, “Guidelines for Referral to a Regional Genetics Service: GPs Respond by Referring More Appropriate Cases,” Family Practice, Vol. 18, No. 2, 2001, pp. 135-140. http://dx.doi.org/10.1093/fampra/18.2.135
[2]	Collaborative Group on Hormonal Factors in Breast Cancer, “Familial Breast Cancer: Collaborative Reanalysis of Individual Data from 52 Epidemiological Studies Including 58209 Women with Breast Cancer and 101986 Women without the Disease,” Lancet, Vol. 358, No. 9291, 2001, pp. 1389-1399. http://dx.doi.org/10.1016/S0140-6736(01)06524-2
[3]	L. K. Nathanson, R. Wooster and B. L. Weber, “Breast Cancer Genetics: What We Know and What We Need,” Nature Medicine, Vol. 7, No. 6, 2001, pp. 552-556. http://dx.doi.org/10.1038/87876
[4]	National Institute for Health and Clinical Excellence, “Familial Breast Cancer: The Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care,” National Health Service (NHS), London, 2006, pp. 15-17.
[5]	National Institute for Health and Clinical Excellence, “Familial Breast Cancer (Update): Guideline Consultation,” National Health Service (NHS), 2010. http://guidance.nice.org.uk/CG/Wave25/1/ Consultation/Latest
[6]	J. M. Grimshaw and I. T. Russell, “Effect of Clinical Guidelines on Medical Practice: A Systematic Review of Rigorous Evaluations,” Lancet, Vol. 342, No. 8883, 1993, pp. 1317-1322. http://dx.doi.org/10.1016/ 0140-6736(93)92244-N
[7]	E. Amir, D. Evans, A. Shenton, F. Lalloo, A. Moran, C. Boggis, M. Wilson and A. Howell, “Evaluation of Breast Cancer Risk Assessment Packages in the Family History Evaluation and Screening Programme,” Journal of Medical Genetics, Vol. 40, No. 11, 2003, pp. 807-814. http://dx.doi.org/10.1136/ jmg.40.11.807
[8]	S. M. Panchal, M. Ennis, S. Canon and L. J. Bordeleau, “Selecting a BRCA Risk Assessment Model for Use in a Familial Cancer Clinic,” BMC Medical Genetics, Vol. 9, 2008, p. 116. http://dx.doi.org/10.1186/1471-2350-9-116
[9]	H. Harris, I. Nippert, C. Julian-Reynier, J. Schmidtke, C. Asperen, D. Gadzicki, A. Tibben and D. G. Evans, “Familial Breast Cancer: Is It Time to Move from a Reactive to a Proactive Role?” Familial Cancer, Vol. 10, No. 3, 2011, pp. 501-503. http://dx.doi.org/10.1007/s10689-011-9434-1
[10]	Z. Ahmed, G. Shields, M. Momin, S. Curran and M. Sugrue, “Breast Cancer family history risk assessment, Fact or Fantasy?” Irish Journal of Medical Sciences, Vol. 179, 2010, p. 338
[11]	B. Baughan, J. Keatings and B. O’Neill, “Urgent Suspected Cancer Referrals from General Practice: Audit of Compliance with Guidelines and Referral Outcomes,” British Journal of General Practice, Vol. 61, No. 592, 2011, pp. 700-706. http://dx.doi.org/10.3399/bjgp11X606591
[12]	D. B. White, V. L. Bonham, J. Jenkins, N. Stevens and C. M. McBride, “Too Many Referrals of Low-Risk Women for BRCA 1/2 Genetic Services by Family Physicians,” Cancer Epidemiology, Biomarkers & Prevention, Vol. 17, No. 11, 2008, pp. 2980-2986. http://dx.doi.org/10.1158/1055-9965.EPI-07-2879
[13]	N. O’Rourke, “Review of Referral Patterns and Triage Processes in Symptomatic Breast Units: A Hospital Perspective,” National Cancer Control Programme, Health Service Executive, Dublin, 2012.
[14]	E. Watson, A. Clements, P. Yudkin, P. Rose, C. Bukach, J. Mackay, A. Lucassen and J. Austoker, “Evaluation of the Impact of Two Educational Interventions on GP Management of Familial Breast/Ovarian Cancer Cases: A Cluster Randomised Controlled Trial,” British Journal of General Practice, Vol. 51, No. 471, 2001, pp. 817-821.