Primary care management of women with breast cancer-related concerns—a dynamic cohort study using a network database

Authors

  • A. Sollie MD, MSc,

    General Practitioner in training and PhD Fellow, Corresponding author
    1. Department of General Practice & Elderly Care Medicine, VU University Medical Centre and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
    2. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
    • Correspondence

      Annet Sollie, Department of General Practice & Elderly Care Medicine, VU University Medical Centre and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.

      Email: j.sollie@vumc.nl

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  • C.W. Helsper MD, PhD, MSc,

    Clinical Epidemiologist
    1. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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  • R.J.M. Ader MD,

    Medical Doctor
    1. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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  • M.G.E.M. Ausems MD, PhD,

    Clinical Geneticist
    1. Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
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  • J.C. van der Wouden PhD,

    Associate Professor, Epidemiologist
    1. Department of General Practice & Elderly Care Medicine, VU University Medical Centre and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
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  • M.E. Numans MD, PhD

    Professor
    1. Department of General Practice & Elderly Care Medicine, VU University Medical Centre and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
    2. Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
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  • Funding

    The Julius Primary Care Network Database is funded by the University Medical Center Utrecht. The research fellowship of AJWS was partly funded by BBMRI (Biobanking and Biomolecular Research Infrastructure) and by the Mondriaan Foundation, an independent organisation which aims to link and enrich routine healthcare databases in the Netherlands for research purposes. The Mondriaan system is funded by TI Pharma, a public-private network. The funders had no role in study design or data collection, analysis or interpretation.

Abstract

The aim of this study was to determine the incidence, management and diagnostic outcomes of breast cancer-related concerns presented in primary care. A dynamic cohort study was performed in the anonymised routine electronic medical records (EMRs) extracted from 49 General Practices in the Netherlands (163,471 person-years, women aged 18–75). Main Outcome Measures were: (1) incidence rates for breast cancer-related concerns in Primary Care, (2) proportions of these women with and without symptoms of the breast referred for further investigation, (3) proportions of referrals (not) according to the guideline and (4) proportions of women with breast cancer-related concerns diagnosed with breast cancer during follow-up. Breast cancer-related concerns are presented frequently in Primary Care (incidence rate 25.9 per 1,000 women annually). About half these women are referred for further investigation. There is room to improve General Practitioner management, mainly for women with an increased lifetime risk of developing breast cancer. Information concerning family history of cancer is often missing in the EMR. Since cancer is rarely diagnosed during follow-up, particularly when symptoms are absent, reduction of unnecessary concerns is plausible if identification of those without an increased risk is improved.

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