Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours

SIMPLE SUMMARY: There is growing international interest in adopting a risk-based approach to breast cancer screening, where an individual’s risk would inform screening practices. It has been suggested that primary care will contribute to the delivery of this service by conducting risk assessment and providing primary prevention advice. The aim of our review was to understand what primary care providers think and feel about performing these tasks by examining their attitudes and typical activity in clinical practice (routine behaviours). The results suggest that primary care providers mainly assess breast cancer risk by collecting family history information but feel less comfortable advising on risk-reducing medications. Primary care will need to proactively assess breast cancer risk for women to get the most benefit from risk-based screening and prevention. To promote risk assessment and prevention activities, improved education/training and changes to resources (integrated risk assessment tools, better patient materials etc.) will be necessary. ABSTRACT: Implementing risk-stratified breast cancer screening is being considered internationally. It has been suggested that primary care will need to take a role in delivering this service, including risk assessment and provision of primary prevention advice. This systematic review aimed to assess the acceptability of these tasks to primary care providers. Five databases were searched up to July–August 2020, yielding 29 eligible studies, of which 27 were narratively synthesised. The review was pre-registered (PROSPERO: CRD42020197676). Primary care providers report frequently collecting breast cancer family history information, but rarely using quantitative tools integrating additional risk factors. Primary care providers reported high levels of discomfort and low confidence with respect to risk-reducing medications although very few reported doubts about the evidence base underpinning their use. Insufficient education/training and perceived discomfort conducting both tasks were notable barriers. Primary care providers are more likely to accept an increased role in breast cancer risk assessment than advising on risk-reducing medications. To realise the benefits of risk-based screening and prevention at a population level, primary care will need to proactively assess breast cancer risk and advise on risk-reducing medications. To facilitate this, adaptations to infrastructure such as integrated tools are necessary in addition to provision of education.