Primary Care Doctors Pivotal in Breast Cancer Screening
Last Updated: 2009-12-14 15:00:28 -0400 (Reuters Health)
SAN ANTONIO (Reuters Health) - Primary care physicians can play a key role in breast cancer prevention, researchers said here at the 32nd Annual San Antonio Breast Cancer Symposium (SABCS).
"I can't get over the number of women who come into my office for surgery for breast cancer that may have been preventable," Dr. Colette A. Salm-Schmid, a breast cancer surgeon with the Aurora BayCare Medical Center in Green Bay, Wisconsin, told Reuters Health. "They have three or four relatives with breast cancer, so you know they're at high risk, yet no one has offered them a drug or told them about preventive measures like diet and exercise."
This is precisely where the primary care physician comes into play, she added. A simple computer program known as the GAIL model, which is available online and free of charge, allows rapid calculation of a patient's risk. The model uses a woman's own personal medical history, her reproductive history, and the history of breast cancer among her first-degree relatives to estimate her risk of developing invasive breast cancer over specific periods of time.
After the patient's risk is calculated, preventive measures can be implemented with possible referral for genetic counseling.
Under the direction of Dr. Salm-Schmid, 16 primary care providers began to screen women between 35 and 69 using the Gail model at their annual examination. Patients were considered high-risk if their 5-year risk exceeded 1.7% or their lifetime risk exceeded 20%.
Overall, 5,724 women were screened over a 12-month period, from May 2007 to May 2008. The vast majority were screened during their routine annual examination, as the initiative recommended, but because physicians spontaneously began to expand the use of the tool, 4% of the calculations were done at other types of visits.
Thirteen percent of the women were high-risk based on the results of the Gail model. These women, and all women over age 40, had screening mammography within 12 months of their examination. Compliance with screening mammography was 100%.
The researchers also documented a boost in referrals to genetic counseling, the comprehensive breast center and breast magnetic resonance imaging.
"Primary care doctors are actually better suited than other physicians to help prevent breast cancer in their high-risk patients," she said. "After all, they're the ones who know how to encourage patients to exercise, lose weight, and decrease their alcohol intake, and so on because that's what they do every day."
The GAIL model can be found on the website of the National Cancer Institute, at http://www.cancer.gov/bcrisktool/.
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