Breast cancer management and the General Practitioner’s role

The general practitioner may have a primary role in the initial screening and diagnosis of breast cancer, but their role following diagnosis is far more limited. Treatment of breast cancer requires the involvement of specialists in different areas of breast cancer diagnosis, treatment, and management. However, even though the active role of the GP is significantly reduced, the family doctor still remains a key figure.

I just want to let you know that I have created a newer version of this page with more up-to-date informatio on General Practitioners. However, this page is kind of out-dated, and short, but it doesn’t mean that you can’t still use it for research material.

The general practitioner plays an important communicative role in breast cancer management

The patient and the GP will hopefully have evolved a trusting relationship over many years, with many ups and downs. In many cases the general practitioner, having made an initial referral, remains as the main communication interface for the breast cancer patient, particularly in relaying important results of biopsies and other scans.

This is a very important and sometimes dramatic role. It is equally common for women to be seen by different doctors at different points in their life, at various clinics, and to not just stick with one family doctor. But once a breast cancer diagnosis occurs it is best if a woman just stick with one family physician. For one thing, they play a key role in gathering all the results of tests.

GPs play an important support and counselling role in breast cancer treatment

The general practitioner can usually be counted on to provide ongoing support and counselling to women, their families and partners, as they adjust to the diagnosis of breast cancer and deal with the results of ongoing treatments and assessments. The general practitioner’s office is also in many cases the ‘filing center‘ for ongoing diagnostic and assessment results, and offers an important opportunity for clear communication of results and possibly further treatment options.

GPs will usually defer to a breast cancer specialist, but can help with day-to-day health issues

Most family doctors, when asked directly about breast cancer treatment options, will often defer to specialists in a rapidly changing field, rather than attempting to offer advice, and this is fair. The main role of the general practitioner once treatment begins is to keep a handle on the emotional health of the patient and those in her immediate and family circle.

Breast cancer patients and their families are generally quite preoccupied with the fear of recurrence, and this can be demonstrated in a variety of subtle physical ways, (lack of sleep, weight gain) and also mental health concerns. The general practitioner can address many of these issues and refer to other mental health specialists and counselors as required.

The GP may continue to address pre-existing and ongoing health issues

The general practitioner will still be called upon to address minor health issues which may have been caused or impacted by breast cancer treatments. A GP can usually offer useful suggestions to alleviate symptoms such as nausea, pain, fatigue, or skin rashes.

In many older women, the breast cancer may have developed on top of pre-existing conditions such as high blood pressure or diabetes, and it is of course prudent for the GP to continue to monitor these ongoing health concerns. Sometimes breast cancer treatments can effect a woman’s ability to work to some degree, and the GP can provide the necessary documentation to address these concerns for employers.

Routine follow-up with a GP for longer term breast cancer survivors might be realistic

Due to the rising costs of health care, there are calls in some circles to allow the general practitioner to take a more active role in the ongoing follow-up of breast cancer. There are strong arguments both for and against in this regard. Obviously, breast cancer treatment is specialized and general practitioners have no training or expertise in administering treatment and evaluating their success.

But bear in mind that over 80% of women who develop breast cancer will be long-term survivors. Breast cancer follow-up and survival is more or less measured in annual to five year, to 10 year intervals, as patients make the transition from ‘treatment follow-up‘ to survivor ship.

GPs help with follow-up, but specialist breast cancer care is better

The main focus of follow-up visits and scans is to check for local recurrence at the site of the primary breast cancer treatment, and this needs to be done in specialized clinics. It is sometimes argued that ‘secondary‘ or metastatic breast cancer (spread to other areas of the body) tends to present as rather obvious, symptomatic disease, so in most cases the function of the the follow-up is to provide reassurance rather than in the detection of asymptomatic recurrence.

Once a patient has completed adjuvant treatments and appears to be disease free in the short-term, it is quite realistic that routine follow-ups could be administered by a general practitioner.

Recent studies have actually shown no significant statistical differences in recurrent and systemic breast cancer detection between general practitioner and specialist follow-up. However, with so many variables and so many different types of breast cancers, it is generally best to receive specialist care and assessment whenever possible.

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For further reading, I suggest you visit this page with information on a multidisciplinary team approach to breast cancer treatment.

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References

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2. Halkett GKB, Arbon P, Scutter SD, Borg M (2005) ‘The experience of making treatment decisions for women with early stage breast cancer: A diagrammatic representation,’ European Journal of Cancer Care 14: 249–255.
3. McWilliam C, Brown J, Stewart, M, (2000) ‘Breast cancer patients’ experiences of patient-doctor communication: A working relationship,’ Patient Education and Counseling 39: 191–204.
4. Wallberg B, Michelson H, Nystedt M, Bolund C, Degner L, Wilking N (2000) ‘Information needs and preferences for participation in treatment decisions among Swedish breast cancer patients,’ Acta Oncologica 39: 467–476.
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6. Anvik T, Holtedahl KA, Mikalsen H. "When patients have cancer, they stop seeing me" – the role of the general practitioner in early follow-up of patients with cancer – a qualitative study. BMC Family Practice 2006, 7:19
7. Holtedahl K, Norum J, Anvik T, Richardsen E: Do cancer patients benefit from short-term contact with a general practitioner following cancer treatment? A randomised, controlled study. Support Care Cancer 2005 , 13:949-956
8. Grunfeld E, Levine MN, Julian JA, Coyle D, Szechtman B, Mirsky DVerma S, Dent S, Sawka C, Pritchard KI, Ginsburg D, Wood M, Whelan T: Randomized trial of long-term follow-up for early-stage breast cancer: a comparison of family physician versus specialist care. J Clin Oncol 2006 , 24:848-855.
9. Grunfeld E: Cancer survivorship: a challenge for primary care physicians. Br J Gen Pract 2005, 55:741-742
10. Jiwa, M., Thompson, J., Coleman, R., Reed, M. Breast Cancer Follow-up: Could Primary Care Be the Right Venue?Curr Med Res Opin. 2006;22(4):625-630.
11. Sakorafas GH, Tsiotou AG, Pavlakis G. Follow-up after primary treatment for breast cancer. Acta Oncol 2000;39:935-40

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