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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>School of Health and Related Research (ScHARR), University of Sheffield. Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care [Internet]. Sheffield (UK): University of Sheffield; 2004 May. (NICE Clinical Guidelines, No. 14.)</p></div><div class="bk_msg_box bk_bttm_mrgn clearfix bk_noprnt"><div class="iconblock clearfix"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/nicecg164guid/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-nicecg164guid-lrg.png" alt="Cover" height="100px" width="80px" /></a><div class="icnblk_cntnt"><ul class="messages"><li class="info icon"><span class="icon"><a href="/books/n/nicecg164guid/">A new version of this title is available</a></span></li></ul></div></div></div><div class="messagearea bk_noprnt" style="margin-bottom:1.3846em "><ul class="messages"><li class="warn icon"><span class="icon">This publication is provided for historical reference only and the information may be out of date.</span></li></ul></div><div class="bk_prnt"><p style="color:red;"><strong>This publication is provided for historical reference only and the information may be out of date.</strong></p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/nicecg14/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-nicecg14-lrg.png" alt="Cover of Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65445_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65445_dtls__"><div>NICE Clinical Guidelines, No. 14.</div><div>School of Health and Related Research (ScHARR), University of Sheffield.</div><div>Sheffield (UK): <a href="https://www.sheffield.ac.uk/scharr" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">University of Sheffield</a>; 2004 May.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/nicecg14/">Contents</a></li></ul></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/nicecg14/ch5/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/nicecg14/ch7/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65445_"><span class="label"> 6</span><span class="title" itemprop="name">Care of women in primary care</span></h1></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="ch6.s1"><h2 id="_ch6_s1_">6.1. Care and management approach – primary care</h2><div id="ch6.s2"><h3>Recommendations</h3><div id="ch6.s3"><h4>Family history taking and initial assessment</h4><ol><li class="half_rhythm"><div><b>When a woman presents with breast symptoms or has concerns about relatives with breast cancer, a first- and second-degree <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> should be taken in primary care to assess <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a>, because this allows appropriate classification and care. (D)</b></div></li><li class="half_rhythm"><div><b>Health care professionals should respond to women who present with concerns, but should not, in most instances, actively seek to identify women with a <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer. (D)</b></div></li><li class="half_rhythm"><div><b>In some circumstances it may also be clinically relevant to take a <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a>, for example for women older than age 35 years using an oral contraceptive pill or for women being considered for long-term HRT use. (D)</b></div></li><li class="half_rhythm"><div><b>Women should be given the opportunity to discuss concerns about their <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer if it is raised during a consultation. (D)</b></div></li><li class="half_rhythm"><div><b>A second-degree <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> (that is, including aunts, uncles and grandparents) should be taken in primary care before explaining risks and options. (D)</b></div></li><li class="half_rhythm"><div><b>A second degree <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> needs to include paternal as well as maternal relatives. (D)</b></div></li><li class="half_rhythm"><div><b>Asking women to discuss their <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> with relatives is useful in gathering the most accurate information. (D)</b></div></li><li class="half_rhythm"><div><b>Tools such as <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> questionnaires and computer packages exist that can aid accurate collection of family history information and they should be made available. (C)</b></div></li><li class="half_rhythm"><div><b>For referral decisions attempts should be made to gather as accurate information as possible on:</b></div><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">age of diagnosis of any cancer in relatives</p></dd><dt>♦</dt><dd><p class="no_top_margin">site of tumours</p></dd><dt>♦</dt><dd><p class="no_top_margin">multiple cancers (including <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d2/">bilateral</a> disease)</p></dd><dt>♦</dt><dd><p class="no_top_margin">Jewish ancestry. (D)</p></dd></dl></li></ol></div><div id="ch6.s4"><h4>Primary care management</h4><dl class="temp-labeled-list"><dt>10.</dt><dd><p class="no_top_margin"><b>Women can be cared for in primary care if the <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> shows only one first-degree or second-degree relative diagnosed with breast cancer at older than age 40 years, provided that none of the following are present in the family history:</b></p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin"><a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d2/">bilateral</a> breast cancer</p></dd><dt>♦</dt><dd><p class="no_top_margin">male breast cancer</p></dd><dt>♦</dt><dd><p class="no_top_margin">ovarian cancer</p></dd><dt>♦</dt><dd><p class="no_top_margin">Jewish ancestry</p></dd><dt>♦</dt><dd><p class="no_top_margin">sarcoma in a relative younger than 45 years of age</p></dd><dt>♦</dt><dd><p class="no_top_margin">glioma or childhood adrenal cortical carcinomas</p></dd><dt>♦</dt><dd><p class="no_top_margin">complicated patterns of multiple cancers at a young age</p></dd><dt>♦</dt><dd><p class="no_top_margin">paternal history of breast cancer (two or more relatives on the father’s side of the family) (D)</p></dd></dl></dd><dt>11.</dt><dd><p class="no_top_margin"><b>Women who do not meet the criteria for referral should be cared for in primary care by giving standard written information (see <a href="/books/n/nicecg14/ch5/box/ch5.box1/?report=objectonly" target="object">Box 1</a>). (D)</b></p></dd></dl></div><div id="ch6.s5"><h4>Referral from primary care</h4><dl class="temp-labeled-list"><dt>12.</dt><dd><p class="no_top_margin"><b>Before a decision on referral is made, primary care professionals should note that a woman outside the 40–49 year age group who is estimated to be at moderate <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> (e.g. she has only one relative with breast cancer diagnosed at any age, or she has two relatives diagnosed with breast cancer older than an average age of 50 years) will not generally be offered additional mammography. (D)</b></p></dd><dt>13.</dt><dd><p class="no_top_margin"><b>Women outside the 40–49 year age group may be referred for <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> counselling and advice on risk management or consideration for prevention trials. Advice should be sought from the designated contact in secondary care about appropriateness of referral. (D)</b></p></dd><dt>14.</dt><dd><p class="no_top_margin"><b>Women who meet the following criteria should be offered referral to secondary care: (D)</b></p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">one first-degree female relative diagnosed with breast cancer at younger than age 40 years</p><p><i>or</i></p></dd><dt>♦</dt><dd><p class="no_top_margin">one first-degree male relative diagnosed with breast cancer at any age</p><p><i>or</i></p></dd><dt>♦</dt><dd><p class="no_top_margin">one first-degree relative with <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d2/">bilateral</a> breast cancer where the first primary was diagnosed at younger than age 50 years</p><p><i>or</i></p></dd><dt>♦</dt><dd><p class="no_top_margin">two first-degree relatives, or one first-degree AND one second-degree relative, diagnosed with breast cancer at any age.</p><p><i>or</i></p></dd><dt>♦</dt><dd><p class="no_top_margin">one first-degree or second-degree relative diagnosed with breast cancer at any age AND one first-degree or second-degree relative diagnosed with ovarian cancer at any age (one of these should be a first-degree relative)</p><p><i>or</i></p></dd><dt>♦</dt><dd><p class="no_top_margin">three first-degree or second-degree relatives diagnosed with breast cancer at any age.</p></dd></dl></dd><dt>15.</dt><dd><p class="no_top_margin"><b>Advice should be sought from the designated secondary care contact if any of the following are present in the <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> in addition to breast cancers in relatives not fulfilling the above criteria:</b></p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin"><a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d2/">bilateral</a> breast cancer</p></dd><dt>♦</dt><dd><p class="no_top_margin">male breast cancer</p></dd><dt>♦</dt><dd><p class="no_top_margin">ovarian cancer</p></dd><dt>♦</dt><dd><p class="no_top_margin">Jewish ancestry</p></dd><dt>♦</dt><dd><p class="no_top_margin">sarcoma in a relative younger than age 45 years</p></dd><dt>♦</dt><dd><p class="no_top_margin">glioma or childhood adrenal cortical carcinomas</p></dd><dt>♦</dt><dd><p class="no_top_margin">complicated patterns of multiple cancers at a young age</p></dd><dt>♦</dt><dd><p class="no_top_margin">paternal history of breast cancer (two or more relatives on the father’s side of the family). <b>(D)</b></p></dd></dl></dd><dt>16.</dt><dd><p class="no_top_margin"><b>Discussion with the designated secondary care contact should take place if the primary care health professional is uncertain about the appropriateness of referral because the <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> presented is unusual or difficult to make clear decisions about, or where the woman is not sufficiently reassured by the standard information provided. (D)</b></p></dd><dt>17.</dt><dd><p class="no_top_margin"><b>Direct referral to a <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d32/">specialist</a> genetics service should take place where a high <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> predisposing <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d8/">gene</a> mutation has been identified (e.g. BRCA1, BRCA2 or TP53). (D)</b></p></dd></dl></div><div id="ch6.s6"><h4>Information for women who are being referred</h4><dl class="temp-labeled-list"><dt>18.</dt><dd><p class="no_top_margin"><b>Women who are being referred to secondary or tertiary care should be provided with written information about what happens at this stage (see <a href="/books/n/nicecg14/ch5/box/ch5.box1/?report=objectonly" target="object">Box 1</a>). (C)</b></p></dd></dl></div><div id="ch6.s7"><h4>Information and ongoing support for women who are not being referred</h4><dl class="temp-labeled-list"><dt>19.</dt><dd><p class="no_top_margin"><b>Support mechanisms (e.g. <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> counselling, psychological counselling, and risk management advice) need to be identified and should be offered to women not eligible for referral and/or surveillance on the basis of age or risk level who have ongoing concerns. (D)</b></p></dd></dl></div><div id="ch6.s8"><h4>Support for primary care</h4><dl class="temp-labeled-list"><dt>20.</dt><dd><p class="no_top_margin"><b>Support is needed for primary care health professionals to care for women with a <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer. Essential requirements for support for primary care are:</b></p><dl class="temp-labeled-list"><dt>♦</dt><dd><p class="no_top_margin">a single point and locally agreed mechanism of referral for women identified as being at increased <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a></p></dd><dt>♦</dt><dd><p class="no_top_margin">educational materials about familial breast cancer</p></dd><dt>♦</dt><dd><p class="no_top_margin">decision-support systems</p></dd><dt>♦</dt><dd><p class="no_top_margin">standardised patient information leaflets</p></dd><dt>♦</dt><dd><p class="no_top_margin">a designated secondary care contact to discuss management of ‘uncertain’ cases. <b>(D)</b></p></dd></dl></dd></dl></div></div><div id="ch6.s9"><h3>6.1.1. Introduction</h3><p>Several studies have reported on a wide range of issues relating to the management of women with a <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer in primary care. These are described in detail in other relevant sections of the document (see family history taking, patient education and information). The evidence from these has informed the recommendations in this chapter.</p><p>The number of primary care consultations where <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer is raised by women is relatively infrequent. A recent study reported that it may be of the order of 5/1000 consultations, which averages out at about 0.6 per clinician per month (<a href="/books/n/nicecg14/references.rl1/#references.r130" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r130/" data-bk-pop-others="" class="bk_pop">Women’s Concerns Study Group 2001</a>). The same study illustrated that if list size and consultation rates were taken into account then an extrapolation of data might mean that for each 1000 women (aged 16 years or over) on a practice list, about 15 per year will raise the issue of family history of breast cancer. They also point out that about 10 times that number will consult for contraceptive advice and three times that number will consult for menstrual disorders. They also found that clinicians were 6.6 times more likely to raise the issue of family history of breast cancer than patients.</p><p>The provision of more genetics services, including <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> assessment, in primary care to allow more appropriate referrals and use of <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d32/">specialist</a> services is an important issue in the management of women with a <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer. However studies have shown that many GPs lack required knowledge and confidence to take on this work. Studies have also shown however that the provision of educational materials to GPs can significantly improve referral decisions for patients with a family history of breast cancer and improve confidence (<a href="/books/n/nicecg14/references.rl1/#references.r289" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r289/" data-bk-pop-others="" class="bk_pop">Watson et al 2001</a>, <a href="/books/n/nicecg14/references.rl1/#references.r288" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r288/" data-bk-pop-others="" class="bk_pop">Watson et al 2002</a>).</p></div></div><div id="ch6.s10"><h2 id="_ch6_s10_">6.2. Patient education/information in primary care</h2><div id="ch6.s11"><h3>6.2.1. Introduction</h3><p>Women may have a hazy notion of their personal breast cancer risks, and of the significance of their family histories. A perceived high <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> may be attributed to cancers in the family that are not associated with a possible genetic predisposition, causing unnecessary anxiety and demands for surveillance. Approximately 25% of referrals to Cancer Genetics Clinics are made for women who are not at increased risk of breast cancer (Wonderling et al 2001): these women, if not offered an appointment for referral, will require reassurance and explanation of the <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a>. In addition, women may lack information and express concerns about the oral contraceptive (OC) pill, HRT and other possible risk factors because there has been breast cancer in the family. Women with a significant family history may feel unprepared for a genetics consultation.</p></div><div id="ch6.s12"><h3>6.2.2. Research literature evidence</h3><div id="ch6.s13"><h4>Studies</h4><div id="ch6.s14"><h5><a href="/books/n/nicecg14/references.rl1/#references.r3" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r3/" data-bk-pop-others="" class="bk_pop">Andermann et al (2002)</a></h5><p>In this UK study, an evidence-based information leaflet was developed after assessing the information needs of women with a <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer, and was subsequently evaluated in a primary care setting. Information leaflets and questionnaires were sent to 190 women referred to a family cancer clinic for breast/ovarian cancer. One hundred and forty-four women returned the questionnaire (response rate of 76%); women had a mean age of 42 years (SD=8.8), were mostly white (98%) and well educated, with 83% having a mother or sister diagnosed with breast cancer.</p><p>Results showed that over 90% of women felt that the leaflet was easy to read and understand, was written in a caring way and was comprehensive. 80% felt that the leaflet was relevant and between 60–70% agreed that it helped them talk to doctors and to family members and was reassuring. Some women, however, felt that the leaflet should not be a substitute for talking to a health care professional.</p></div><div id="ch6.s15"><h5><a href="/books/n/nicecg14/references.rl1/#references.r94" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r94/" data-bk-pop-others="" class="bk_pop">Grande et al (2002)</a></h5><p>In a UK qualitative study, women’s views of <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d9/">GP</a> consultations about <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer were investigated using 72 telephone interviews and a further 20 face-to-face interviews with a subsample of 20 women. Participants were women from 18 GP practices (mean age 49 years; range 34–76 years) who had experienced a primary care consultation in which breast cancer family history was mentioned, as reported by the clinician. Results found that family history of breast cancer was rarely the main focus of consultations. Women’s understanding of familial <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> and disease was often lacking and they expressed a need for clarification, explanation and information. The authors’ conclude that the GP’s main role in relation to family history and cancer risk is to provide appropriate reassurance for the majority of patients not at increased risk.</p></div><div id="ch6.s16"><h5><a href="/books/n/nicecg14/references.rl1/#references.r5" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r5/" data-bk-pop-others="" class="bk_pop">Andermann et al (2001)</a></h5><p>A survey of 128 UK women with a <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer (mean age 38 years; SD=10.0) referred by their <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d9/">GP</a> to secondary care (genetics or breast clinic) was carried out to explore women’s views, expectations and experiences of the process. 90% of women wanted their GP to provide them with information and 87% wanted their GP to discuss their risks of developing breast cancer, and for most women these needs had not been met. Women often had unrealistic expectations of what they might expect from a secondary care referral, particularly in terms of genetic testing. 11% of women had returned to their GP within 1 month of attending the secondary care appointment to discuss family history and what had happened at the <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d32/">specialist</a> clinic. Study results indicate that women want information and want to discuss their family history concerns in a primary care setting. Information provision in primary care is even more important for women who are not referred, as this may be their only source of information and advice.</p></div><div id="ch6.s17"><h5><a href="/books/n/nicecg14/references.rl1/#references.r33" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r33/" data-bk-pop-others="" class="bk_pop">Chalmers et al (1996)</a></h5><p>The role of information, support and communication needs was evaluated in this Canadian qualitative study involving 55 at-<a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> women with at least one first-degree relative with breast cancer. Results showed that information, support and communication were important factors in enabling women to adjust to their personal risk of breast cancer, articulated as a 3-phase process: ‘living the breast cancer experience’ through the relative’s experience; developing a risk perception; and ‘putting risk in its place’. However, despite the importance of information and support, most women were dissatisfied with the amount and type of information they received and felt isolated and unsupported, and communication both within the family and with health care professionals was poor. The authors conclude that women’s needs could be more effectively addressed by measures that identify at-risk women, assess their specific needs, and provide them with support and accurate, individualised information.</p></div></div></div><div id="ch6.s18"><h3>6.2.3. Summary of evidence relating to patient information in a primary care setting for women with a family history of breast cancer</h3><p>Evidence from two qualitative studies and one survey has shown that women with a <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer have unmet needs for information, support and reassurance either in the primary care setting (<a href="/books/n/nicecg14/references.rl1/#references.r33" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r33/" data-bk-pop-others="" class="bk_pop">Chalmers et al, 1996</a>; <a href="/books/n/nicecg14/references.rl1/#references.r94" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r94/" data-bk-pop-others="" class="bk_pop">Grande et al, 2002</a>), or whilst awaiting <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d32/">specialist</a> genetics consultations having been referred by their <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d9/">GP</a> (<a href="/books/n/nicecg14/references.rl1/#references.r5" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r5/" data-bk-pop-others="" class="bk_pop">Andermann et al, 2001</a>). The GP’s role in providing information and reassurance was seen to be extremely important for these women, particularly for those who are not referred to secondary care, as the GP may be their only source of information and advice.</p><p>A further study which developed and evaluated a research-based leaflet for women with a <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of cancer for use in a primary care setting found that it was effective in meeting women’s information (<a href="/books/n/nicecg14/references.rl1/#references.r3" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r3/" data-bk-pop-others="" class="bk_pop">Andermann et al, 2002</a>).</p></div><div id="ch6.s19"><h3>6.2.4. Comment</h3><p>Primary care professionals have an important part to play in the care of women with concerns about their <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer. Issues about family history of breast cancer are often raised by primary care professionals in routine consultations (<a href="/books/n/nicecg14/references.rl1/#references.r130" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r130/" data-bk-pop-others="" class="bk_pop">Hyland et al 2001</a>) but women may not be given the opportunity to discuss concerns they have about their <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> of breast cancer (<a href="/books/n/nicecg14/references.rl1/#references.r94" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r94/" data-bk-pop-others="" class="bk_pop">Grande et al 2002</a>). Although the case is not yet made for screening all women for a family history of breast cancer, primary care professionals should be alert to the fact that women may have concerns about their family history which they wish to have addressed.</p><p>Taking an adequate <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> that covers first and second degree relatives on both sides of the family is central to providing women with an initial assessment of their <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a> in primary care. Patients may be uncertain about the details of their family history on initial questioning but can often obtain this information by asking family members; this enables a more accurate assessment of their risk in primary care.</p><p>The majority of women with a <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d7/">family history</a> of breast cancer will not be at substantially increased <a class="def" href="/books/n/nicecg14/glossary.gl1/def-item/glossary.gl1-d27/">risk</a>. In these circumstances, primary care professionals should discuss the woman’s risk of breast cancer and advise her about breast awareness, relevant lifestyle factors and the NHS National Breast Screening Programme. Women who are at significantly increased risk of breast cancer should be offered referral for a more detailed discussion of their risk. Women who are referred about their risk of breast cancer often have unrealistic expectations of the outcome of referral (<a href="/books/n/nicecg14/references.rl1/#references.r5" data-bk-pop-rid="/books/n/nicecg14/references.rl1/def-item/references.r5/" data-bk-pop-others="" class="bk_pop">Andermann et al 2001</a>). Primary care professionals therefore have an important role in preparing women and providing them information about what to expect from referral and supporting them afterwards with the ongoing management of their breast cancer risk.</p></div></div><div id="bk_toc_contnr"></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2004, School of Health and Related Research (ScHARR), University of Sheffield.</div><div class="small"><span class="label">Bookshelf ID: NBK65445</span></div><div style="margin-top:2em" class="bk_noprnt"><a class="bk_cntns" href="/books/n/nicecg14/">Contents</a><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/nicecg14/ch5/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/nicecg14/ch7/" title="Next page in this title">Next ></a></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65445/?report=reader">PubReader</a></li><li><a href="/books/NBK65445/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65445" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65445" style="display:none" title="Cite this Page"><div class="bk_tt">School of Health and Related Research (ScHARR), University of Sheffield. Clinical Guidelines for the Classification and Care of Women at Risk of Familial Breast Cancer in Primary, Secondary and Tertiary Care [Internet]. Sheffield (UK): University of Sheffield; 2004 May. (NICE Clinical Guidelines, No. 14.) 6, Care of women in primary care.<span class="bk_cite_avail"></span></div></div></li><li><a href="/books/n/nicecg14/pdf/">PDF version of this title</a> (7.0M)</li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#ch6.s1" ref="log$=inpage&link_id=inpage">Care and management approach – primary care</a></li><li><a href="#ch6.s10" ref="log$=inpage&link_id=inpage">Patient education/information in primary care</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Other titles in this collection</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="source-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/n/nicecollect/">National Institute for Health and Clinical Excellence: Guidance
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