Making Best Practice, Every Day Practice
Breast pain, also known as mastalgia and mastodynia, is the commonest reason for consultation about breast problems in both UK primary care and breast units. Most women can be managed by their GPs with reassurance, advice and first-line treatments, but it is essential to identify women who need referral, especially the small minority presenting with pain as a symptom of breast cancer.
The human papillomavirus (HPV) is responsible for 99% of cervical cancers, and vaccines are now available that make it possible to protect girls before they become sexually active. However, vaccinating schoolgirls against a virus that is contracted through sexual contact is a controversial topic, provoking questions from young women and their parents. To encourage young women to accept this potentially life-saving vaccine, it is important that GPs and practice nurses are able to answer patients’ questions about HPV.
Women with a family history of breast cancer are increasingly proactive in seeking help. As a result, breast centres and cancer genetics departments have seen an increase in referrals. This has no doubt had repercussions for workload in primary care, especially given the updated guideline on familial breast cancer from the National Institute for Health and Care Excellence (NICE). These recommendations have lowered the threshold for genetic testing, and have introduced the possibility of chemoprevention with tamoxifen or raloxifene.
In the UK, more women die from lung cancer than any other cancer, including breast cancer. Smoking is by far the commonest cause, and lung cancer rates are continuing to rise in women who started to smoke in the 1960s. It is never too late for anyone to give up smoking, even after a diagnosis with lung cancer, when early intervention may result in cure or significantly prolong life.
Vulval cancer is primarily a disease of elderly women, but is increasingly seen before the menopause. It is a rare disease, and a primary care health professional may see only one case every seven years. It is, however, essential for GPs and practice nurses to be aware of the early signs and symptoms of vulval cancer, since it is highly curable if diagnosed and treated at an early stage.
Primary care is usually the first point of contact when a woman presents with postmenopausal bleeding (PMB). Prompt referral is essential, since bleeding may be a sign of endometrial cancer. But it is also important for GPs and practice nurses to explain to the patient the reasons for concern, as well as the purpose of the investigations that she is likely to encounter in secondary care.
Recommendations from the National Institute for Health and Clinical Excellence (NICE) aim to prompt rapid investigation of women with patterns of symptoms suggestive of ovarian cancer. But this is just one of a plethora of guidance for primary care, and incorporating it into our daily practice remains challenging. So how should we apply the NICE ovarian cancer guidelines to our patients?
Over the last 30 years, there has been a threefold increase in the number of cancer survivors. As a result more women are living with the long-term side-effects of their treatment. Gastrointestinal (GI) symptoms after pelvic radiotherapy are especially important, as they are common and impair quality of life. Since patients are likely to present in primary care, GPs and practice nurses can help to ensure appropriate initial management and referral.
Many people have close relatives with cancer, and the possibility of inherited risk is increasingly raised during a GP consultation, often by patients themselves. It is important to identify the small but significant proportion of people who are at greatly increased risk of developing cancer as a result of their family history. But most patients with a family history are not at higher risk, and can be managed in primary care.
Think of a disease in which diagnostic delay may kill the patient, yet early diagnosis is extremely difficult. Add that the disease is quite rare, and symptoms mimic much more common benign conditions. If that is not tough enough, screening has not (yet) been shown to be helpful, and the primary diagnostic test is quite specialised. Does this add up to a problem? Of course it does, and the diagnostic nightmare is ovarian cancer.
There are over 37,000 new cases of lung cancer each year in the UK and it is the most common cancer in males and second most common after breast cancer in females. The role of the multidisciplinary team is essential in the management of these patients and it is important for all members of the team to know the signs to look for and actions to take in cases of suspected lung cancer. This article reviews the current methods of diagnosis and treatments available for lung cancer and the role of the primary healthcare professional.
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