Raising concerns about family history of breast cancer in primary care consultations: prospective, population based study

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Abstract
Population, method, and results Nineteen of the 36 partnerships with four or more partners in one health authority were recruited by letter and visit (mean list size 8904 (SD 2231); 74% training practices). A total of 240 clinicians participated: 152 doctors and 88 nurses, including locums and those working part time. Each practice collected data over four weeks between August 1997 and July 1998. After all consultations with women aged 16 or older, clinicians recorded the patient's reference number, birth date, mention of a family history of breast cancer or other cancers, breast symptoms, risk of breast cancer, and who first mentioned any of these topics. Consultation data were checked against records of attendance at the practice. Agreement between the patient and clinician on who first mentioned a family history of breast cancer was assessed in a selected subsample of women. These women were invited to participate in a telephone interview by letter (no reminders). Respondents included 39 of 107 women classified as originating discussion of a family history of breast cancer and 33 of a 10% sample of those classified as not originating such discussions (total 681). Data were double-entered and analysed using STATA 5.0 (Statacorp, College Station, TX). Eighteen of 19 practices participated, and 20 614 of 24 269 consultations (85%) were usable. A sensitivity analysis that assumed that all missing consultations came from the practice with the highest or lowest rate of reporting for a family history of breast cancer gave results within the confidence intervals of the main analysis. No differences in frequency of mentions of family history of breast cancer by clinicians were found over time. Of the topics recorded, breast symptoms were mentioned in consultation most often, and family history of cancers other than breast cancer least often (table). Mention of a family history of breast cancer was recorded in 3.7% of consultations. Clinicians were 6.6 times more likely to raise the issue of family history of breast cancer than were women and were more likely to raise the issue in all topics counted. View this table: In this window In a new window Consultations (n=20 614*) in which topics relating to breast cancer were mentioned. Values are number (%; 95% CI) Fifty of 72 women interviewed recalled mention of family history of breast cancer during their consultation; 42/50 agreed with the reporting clinician as to who raised the issue. Those disagreeing reported that the clinician, and not themselves, had done so. Five women reported consulting with specific concerns about family history of breast cancer. Acknowledgments We thank all the participating practice managers, general practitioners, practice nurses, and receptionists in the following practices of the Cambridge and Huntingdon Health Authority: Dr Brimblecombe and partners, Dr Brodie and partners, Dr Draper and partners, Dr Ferreira and partners, Dr Gant and partners, Dr Grande and partners, Dr Hewlett and partners, Dr Horne and partners, Dr Irons and partners, Dr King and partners, Dr Kuczynska and partners, Dr Kuczynski and partners, Dr Newby and partners, Dr Ridsdill-Smith and partners, Dr Sackin and partners, Dr Smerdon and partners, Dr Smith and partners, Dr Tulloch and partners, Dr Woods and partners. We thank Anna Martin, research assistant in the General Practice and Primary Care Research Unit, Cambridge, for her contribution to data collection and Julie Grant who coordinated and produced the manuscript. Joan Austoker, Truuske De Bock, Arthur Hibble, Frankie Lasman, Paul Pharoah, and Ron Zimmern gave valuable support and advice. Contributors: This paper is authored by the Women's Concerns Study Group, which comprises Fawzia Hyland, Ann Louise Kinmonth, Theresa M Marteau (writing committee); Simon Griffin, Paul Murrell, David Spiegelhalter, Chris Todd, Fiona Walter (study executive); Bob Berrington, Martin Bobrow, and James Mackay (co-applicants). All authors have commented on and approved the manuscript, and ALK will act as a guarantor. Further details of the authors' affiliations are given on the website.