Breast health, including breast cancer early detection and prevention, assessing and managing breast skin changes, and premature breast development are the focus of the latest issue of the Australian Journal of General Practice (AJGP).
As the peer-reviewed journal of the Royal Australian College of GPs (RACGP), the AJGP keeps GPs updated on the latest research and provides information to assist them in providing high quality care.
RACGP President Dr Michael Wright said: "Breast cancer is the most-diagnosed cancer among female patients in Australia and the second-leading cause of female cancer deaths, so it's an important topic to discuss with your GP.
"This edition of the AJGP updates GPs on the latest evidence to guide breast cancer treatment and prevention. Other articles provide guidance on managing a range of dermatological conditions and assessing and managing early development, making it a valuable resource for all GPs."
An article by GP Dr Sandy Minck provides guidance for GPs on evidence-based strategies for breast cancer prevention.
Dr Minck, who undertook a risk-reducing mastectomy in 2023 and is a member of BreastScreen Queensland's Clinical Standards and Excellence Committee, said there are a range of preventive options for patients.
"More than 75% of cases occur in patients over 50, but there has been a 10% increase among patients under 50 in the last 20 years, so breast cancer will be a concern for younger patients too," Dr Minck said.
"Lifestyle changes, medication, and surgical interventions can reduce breast cancer risk. These include maintaining a healthy weight, avoiding or limiting alcohol, and getting regular exercise.
"Risk-reducing medication can decrease breast cancer risk by 30–60%. There are two main categories of medication, selective estrogen receptor modulators and aromatase inhibitors. These are an effective risk-reducing strategy for patients who do not want to undergo, or want to postpone, mastectomy.
"Risk-reducing surgery is an option for those at very high risk of developing breast cancer. This can be overwhelming, and GPs can support women to make their own informed decision based on their individual risk, values, circumstances, and the potential benefits and risks of surgery.
"Awareness is the first step, so please discuss any family history of breast cancer with your GP, become familiar with the normal look and feel of your breasts, and promptly speak to your GP about any new or unusual changes."
A separate article updates GPs on the early detection of breast cancer, informed by the 10th edition of the RACGP's Red Book preventive health guidelines for breast cancer.
Authors Professor Danielle Mazza AM, RACGP Red Book Chair, and Professor Jon Emery, Herman Chair of Primary Care Cancer Research at the University of Melbourne, emphasise GPs' critical role in assessing individual risk.
"Your GP can give you an individual risk assessment and organise referral for genetic testing if your family history puts you at increased risk of developing breast cancer," Professor Mazza said.
"One aim of this publication is to give GPs the latest evidence guiding on screening and risk assessment for breast cancer. This involves reviewing a patient's family history, genetic predisposition, and other relevant factors.
"The most important risk factors are genetic, particularly if a patient carries high-risk BRCA1 or BRCA2 genetic mutations or a significant family history.
"For female patients over 50 without symptoms, it's important to undergo a mammography every two years. Some patients may want to begin screening in their 40s, though evidence for this age cohort is less robust.
"Patients with moderate breast density also have around 1.5 times the risk of breast cancer, and dense breast tissue can make it hard to see small masses in a mammogram, potentially delaying diagnosis. While women with dense breasts are more likely to benefit from supplemental screening modalities such as ultrasound or MRI, there is insufficient evidence to recommend routine supplemental screening in this patient group."
The breast health issue of the AJGP also features articles on assessing and managing breast skin changes; assessing premature thelarche, or early breast development; and a clinical challenge on breast health topics which allows GPs to complete five hours of RACGP-approved continuing professional development.
A free webinar for RACGP members on 29 May will update GPs on the latest in lung, cervical, and breast cancer screening.
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