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.
Gynaecology rapid-access clinics allow prompt assessment by specialists of women with suspected gynaecological malignancy, with the aim of improving cancer outcomes and patient experience, and ultimately reducing mortality. However, the ability of trusts to assess and treat women within specified targets relies on appropriate referral from primary care. Without this, fast-track services become overwhelmed with women who could be assessed by a routine referral, potentially delaying the review of women with suspected malignancy and creating unnecessary patient anxiety.
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.
The NHS Cervical Screening Programme is universally lauded as a success story, preventing an estimated 2,000 deaths a year from cervical cancer in the UK. The programme continues to be refined in light of new evidence, and the latest development is the introduction of human papilloma virus (HPV) testing alongside cytology.
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