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 patie...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 1st 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 1st degree relatives would enhance the referral process.展开更多
Background: Although well established, population based screening and family risk assessment for breast cancer have come under increasing scrutiny. The concept of over diagnosis is increasingly cited in cancer publica...Background: Although well established, population based screening and family risk assessment for breast cancer have come under increasing scrutiny. The concept of over diagnosis is increasingly cited in cancer publications. This study assessed the impact of failure to screen or risk assess patients attending with a new diagnosis of breast cancer. Methods: A retrospective review was undertaken of 200 consecutive patients diagnosed with breast cancer between January 2010 and September 2012 at Letterkenny Hospital. Appropriate screening was defined as biennial in those aged 50 - 66 and in those 40 - 49 with moderate/high family history risk (NICE criteria or IBIS criteria). Patient demographics, screening history, diagnosis date and stage (TNM) were?documented. Patients with previous breast cancer were not included (n = 17). Results: 200 consecutive patients, whose mean age was 61 (range 28 - 99), were studied. 112/200 (56%) met no criteria for screening or family history assessment, and 88/200 (44%) met criteria for either screening (in 56) or family history assessment (in 32). 61/88 (69.3%) meeting criteria did not have a mammogram or risk assessment. The stage of breast cancer was significantly earlier in those screened appropriately, with early stage cancer in n = 111/139 (79.9 %) and late in n = 28/139 (20.1%), compared with 38/61 (62.3%) and 23/61 (37.7%) in those failing to be screened appropriately (p = 0.01?χ2?df1). Conclusion:?Failure to engage in breast screening and risk assessment resulted in more advanced stage at diagnosis.展开更多
文摘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 1st 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 1st degree relatives would enhance the referral process.
文摘Background: Although well established, population based screening and family risk assessment for breast cancer have come under increasing scrutiny. The concept of over diagnosis is increasingly cited in cancer publications. This study assessed the impact of failure to screen or risk assess patients attending with a new diagnosis of breast cancer. Methods: A retrospective review was undertaken of 200 consecutive patients diagnosed with breast cancer between January 2010 and September 2012 at Letterkenny Hospital. Appropriate screening was defined as biennial in those aged 50 - 66 and in those 40 - 49 with moderate/high family history risk (NICE criteria or IBIS criteria). Patient demographics, screening history, diagnosis date and stage (TNM) were?documented. Patients with previous breast cancer were not included (n = 17). Results: 200 consecutive patients, whose mean age was 61 (range 28 - 99), were studied. 112/200 (56%) met no criteria for screening or family history assessment, and 88/200 (44%) met criteria for either screening (in 56) or family history assessment (in 32). 61/88 (69.3%) meeting criteria did not have a mammogram or risk assessment. The stage of breast cancer was significantly earlier in those screened appropriately, with early stage cancer in n = 111/139 (79.9 %) and late in n = 28/139 (20.1%), compared with 38/61 (62.3%) and 23/61 (37.7%) in those failing to be screened appropriately (p = 0.01?χ2?df1). Conclusion:?Failure to engage in breast screening and risk assessment resulted in more advanced stage at diagnosis.
