October 30, 2014 | by Tami Dennis
Breast cancer risk is personal; breast cancer risk assessment should be, too. To that end, City of Hope researchers have developed a starting point to help women (and their doctors) with a family history of the disease begin that risk assessment process.
The result is an iPhone app, called BRISK, for Breast Cancer Risk Assessment Application. It’s the work of City of Hope’s Division of Research Informatics, in collaboration with the Division of Clinical Cancer Genetics.
For women with a family history of the disease, the app walks them through their age-specific risk of developing the disease, beginning with a question about whether the family history involved a first-degree relative, a second-degree relative, a mother and paternal aunt, and so on.
The app clearly cautions that it is not fail-safe. It is not a substitution for a formal cancer risk assessment by a skilled physician. It doesn’t include risk factors other than family history, and it’s not to be used by women who are carriers of gene mutations making them more susceptible to breast cancer.
But it does help women and their physicians gain some perspective.
Here, Bita Nehoray, a genetic counselor in the Division of Clinical Cancer Genetics, answers questions about the app, its purpose and how it should be used:
What was the purpose behind this breast cancer app?
The BRisk app is an electronic tool that allows women or their physicians to do quick and easy age-adjusted calculations using what clinicians refer to as the Claus tables. The Claus tables are the result of a breast cancer risk prediction model for women with a family history of breast or ovarian cancer. The tables allow you to calculate breast cancer risk based on degree of relatedness and age at onset of family members with breast cancer, as well as number of close blood relatives with ovarian cancer.
Clinicians already use the "Claus tables" in calculating breast cancer risk and prescribing appropriate screening, but doing age-adjusted calculations to personalize risk for these women is quite cumbersome. The BRisk app makes those calculations much easier.
What does the app hope to achieve?
With this app, clinicians can calculate their patient's breast cancer risk. One of the goals is to determine if a woman has greater than 20 percent risk. Those that fall into this category qualify for annual breast MRI as an addition to their breast screening per American Cancer Society guidelines. You can read more about this in the study, "American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography," cited on the resources tab of the app.
The breast cancer app seems to imply that only women who have a relative with breast cancer or who have had breast cancer themselves are at risk. We all know that's not true, so how this should app be presented? Is it only for a certain subset of women?
You are correct in that all women are at risk for breast cancer. This app is only for women who have never had breast cancer (or ductal carcinoma in situ) who have a family history of breast or ovarian cancer.
Looking at the app, you can also see that for some women, their family history of breast or ovarian cancer will not be captured by the scenarios provided (e.g., two first-degree relatives). That is not to say that if your family history doesn't fit one of the scenarios provided that you do not have breast cancer risk or that it is not significant. Any woman who is interested in learning more about her risk for cancer (whether due to genetic susceptibility or not) should speak to a clinician skilled in genetic cancer risk assessment.
Are there plans to develop a more complete assessment app? This app's focus is using the Claus tables. Certainly there are other risk factors for breast cancer that are not captured here and other models are available for use (each with its own set of benefits and limitations). The Gail model is one such model, as is Tyrer-Cuzick. While we are developing other tools to aid clinicians in cancer risk assessment, most likely the BRisk app will be incorporated as one option as the data used to create the model is static.
What kind of feedback have you gotten about the breast cancer app?
We've heard from several clinicians across various disciplines (oncology, surgery, genetics) that they love using the app because it is quick and easy to use. Many were excited when it became available for iPhones, and many are asking if we will be able to make this app compatible with Android technology. That's uncertain at this point, but we do have an email contact available to those who have feedback or questions ([email protected]).
Learn more about breast cancer treatment and research at City of Hope.
Learn more about becoming a patient or getting a second opinion by visiting our website or by calling 800-826-HOPE (4673). City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.