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Review

Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours

1
Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
2
Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
3
NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
*
Author to whom correspondence should be addressed.
Academic Editor: David N. Danforth
Cancers 2021, 13(16), 4150; https://doi.org/10.3390/cancers13164150
Received: 29 July 2021 / Revised: 16 August 2021 / Accepted: 17 August 2021 / Published: 18 August 2021
(This article belongs to the Special Issue Risk Assessment for Breast Cancer)
There is growing international interest in adopting a risk-based approach to breast cancer screening, where an individual’s risk would inform screening practices. It has been suggested that primary care will contribute to the delivery of this service by conducting risk assessment and providing primary prevention advice. The aim of our review was to understand what primary care providers think and feel about performing these tasks by examining their attitudes and typical activity in clinical practice (routine behaviours). The results suggest that primary care providers mainly assess breast cancer risk by collecting family history information but feel less comfortable advising on risk-reducing medications. Primary care will need to proactively assess breast cancer risk for women to get the most benefit from risk-based screening and prevention. To promote risk assessment and prevention activities, improved education/training and changes to resources (integrated risk assessment tools, better patient materials etc.) will be necessary.
Implementing risk-stratified breast cancer screening is being considered internationally. It has been suggested that primary care will need to take a role in delivering this service, including risk assessment and provision of primary prevention advice. This systematic review aimed to assess the acceptability of these tasks to primary care providers. Five databases were searched up to July–August 2020, yielding 29 eligible studies, of which 27 were narratively synthesised. The review was pre-registered (PROSPERO: CRD42020197676). Primary care providers report frequently collecting breast cancer family history information, but rarely using quantitative tools integrating additional risk factors. Primary care providers reported high levels of discomfort and low confidence with respect to risk-reducing medications although very few reported doubts about the evidence base underpinning their use. Insufficient education/training and perceived discomfort conducting both tasks were notable barriers. Primary care providers are more likely to accept an increased role in breast cancer risk assessment than advising on risk-reducing medications. To realise the benefits of risk-based screening and prevention at a population level, primary care will need to proactively assess breast cancer risk and advise on risk-reducing medications. To facilitate this, adaptations to infrastructure such as integrated tools are necessary in addition to provision of education. View Full-Text
Keywords: primary care; breast cancer; risk assessment; primary prevention; systematic review primary care; breast cancer; risk assessment; primary prevention; systematic review
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MDPI and ACS Style

Bellhouse, S.; Hawkes, R.E.; Howell, S.J.; Gorman, L.; French, D.P. Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours. Cancers 2021, 13, 4150. https://doi.org/10.3390/cancers13164150

AMA Style

Bellhouse S, Hawkes RE, Howell SJ, Gorman L, French DP. Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours. Cancers. 2021; 13(16):4150. https://doi.org/10.3390/cancers13164150

Chicago/Turabian Style

Bellhouse, Sarah, Rhiannon E. Hawkes, Sacha J. Howell, Louise Gorman, and David P. French 2021. "Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours" Cancers 13, no. 16: 4150. https://doi.org/10.3390/cancers13164150

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