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Improving primary care identification of familial breast cancer risk using proactive invitation and decision support

Qureshi, Nadeem; Dutton, Brittany; Weng, Stephen; Sheehan, Christina; Chorley, Wendy; Robertson, John F.R; Kendrick, Denise; Kai, Joe


Stephen Weng

Christina Sheehan

Wendy Chorley

Professor of Primary Care Research


Family history of breast cancer is a key risk factor, accounting for up to 10% of cancers. We evaluated the proactive assessment of familial breast cancer (FBC) risk in primary care. Eligible women (30 to 60 years) were recruited from eight English general practices. Practices were trained on familial breast cancer risk assessment. In four randomly-assigned practices, women were invited to complete a validated, postal family history questionnaire, which practice staff inputted into decision support software to determine cancer risk. Those with increased risk were offered specialist referral. Usual care was observed in the other four practices. In intervention practices, 1127/7012 women (16.1%) returned family history questionnaires, comprising 1105 (98%) self-reported white ethnicity and 446 (39.6%) educated to University undergraduate or equivalent qualification, with 119 (10.6%) identified at increased breast cancer risk and offered referral. Sixty-seven (56%) women recommended referral were less than 50 years old. From 66 women attending specialists, 26 (39.4%) were confirmed to have high risk and recommended annual surveillance (40-60 years) and surgical prevention; while 30 (45.5%) were confirmed at moderate risk, with 19 offered annual surveillance (40–50 years). The remaining 10 (15.2%) managed in primary care. None were recommended chemoprevention. In usual care practices, only ten women consulted with concerns about breast cancer family history. This study demonstrated proactive risk assessment in primary care enables accurate identification of women, including many younger women, at increased risk of breast cancer. To improve generalisability across the population, more active methods of engagement need to be explored.


Qureshi, N., Dutton, B., Weng, S., Sheehan, C., Chorley, W., Robertson, J. F., …Kai, J. (2020). Improving primary care identification of familial breast cancer risk using proactive invitation and decision support. Familial Cancer,

Journal Article Type Article
Acceptance Date May 18, 2020
Online Publication Date Jun 11, 2020
Publication Date Jun 11, 2020
Deposit Date May 20, 2020
Publicly Available Date Jun 15, 2020
Journal Familial Cancer
Print ISSN 1389-9600
Electronic ISSN 1573-7292
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Keywords Genetics(clinical); Genetics; Cancer Research; Oncology
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Additional Information Received: 1 March 2020; Accepted: 18 May 2020; First Online: 11 June 2020; : ; : NQ was a member of the English NICE guideline development group on “Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer” (CG 164), he has received honorarium from AMGEN for talks on Familial Hypercholesterolaemia. SW is a member of the CPRD Independent Scientific Advisory Committee at the UK MHRA, has received honorarium as an advisor to AMGEN-EU scientific advisory board for data science. JFRR has consulted for AstraZenca, Bayer, Carrick Therapeutics & Cullinan Oncology. He also has provided expert testimony for AstraZeneca. He holds shares in Oncimmune Holdings, FaHRAS Ltd and Carrick Therapeutics. The remaining authors have no conflicts to disclose.; : The study was approved by East Midlands National Research Ethics Service (NRES) Committee (Reference 14/EM/0009).


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