Opinion

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Breast cancer screening and COVID: GPs’ role

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Breast cancer is the second most commonly diagnosed cancer in Australia and the most common cancer in females.
 
If detected early, the five-year survival rate is 91%.
 
GPs are often the first point of contact for women and men with new breast symptoms. They also play an integral role in prevention, through screening for risk factors and risk reduction.
 
Data from the Victorian Cancer Registry shows that cancer pathology notifications declined for all tumour streams by up to 27% from 1 April to 30 June 2020.
 
This is partly due to the recent temporary suspension of activity of BreastScreen Australia (due to the COVID-19 pandemic), coupled with symptomatic women delaying presentation or not responding to routine screening invitations.
 
BreastScreen has now reopened with reduced screening capacity, which has been necessary in order to implement COVID-19 safety measures.
 
It is pertinent to remind health professionals that a screening mammogram is used to check for breast cancer in women who have no signs or symptoms.
 
Symptomatic patients should be referred privately for a diagnostic mammogram, or to a public hospital imaging department that provides free diagnostic imaging.
 
While GPs should continue to encourage patients to continue routine breast cancer screening, we should also make an attempt to stratify risk in our patients.
 
GPs should screen all women (and men) for breast cancer risk factors, including:

• age
• lifestyle – obesity, poor diet, lack of exercise/physical inactivity, smoking, alcohol intake
• personal factors – prior breast cancer, mantle radiotherapy, hormone replacement therapy  use
• family history – young age breast and ovarian cancer, known genetic mutations such as BRCA 1 or BRCA 2, Ashkenazi Jewish heritage.

GPs should also become familiar with risk assessment tools such as iPrevent, a breast cancer risk assessment and management decision support tool endorsed by the RACGP. It aims to facilitate discussions around prevention and screening between women and their doctors.
 
Please encourage your patients to not delay presentation and screening, as delays have serious consequences, making treatment more challenging and jeopardising treatment outcomes and survival.
 
Please also encourage all patients to present to you if they notice any new breast symptoms, despite COVID-19.
 
We should remind all our patients that cancer does not wait due to the COVID-19 pandemic, and draw their attention to the recent campaign launched by Cancer Australia, ‘Cancer Won’t Wait’.

Written in collaboration with the Victorian COVID-19 Cancer Network (VCCN) Breast Advisory Group.
 
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breast cancer cancer screening COVID-19 preventive health

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