Identification and Management of Women at High Risk for Hereditary Breast/Ovarian Cancer Syndrome

Abstract

Despite advances in identifying genetic markers of high risk patients and the availability of genetic testing, it remains challenging to efficiently identify women who are at hereditary risk and to manage their care appropriately. HughesRiskApps, an open-source family history collection, risk assessment, and Clinical Decision Support (CDS) software package, was developed to address the shortcomings in our ability to identify and treat the high risk population. This system is designed for use in primary care clinics, breast centers, and cancer risk clinics to collect family history and risk information and provide the necessary CDS to increase quality of care and efficiency. This paper reports on the first implementation of HughesRiskApps in the community hospital setting. HughesRiskApps was implemented at the Newton-Wellesley Hospital. Between April 1, 2007 and March 31, 2008, 32,966 analyses were performed on 25,763 individuals. Within this population, 915 (3.6%) individuals were found to be eligible for risk assessment and possible genetic testing based on the 10% risk of mutation threshold. During the first year of implementation, physicians and patients have fully accepted the system, and 3.6% of patients assessed have been referred to risk assessment and consideration of genetic testing. These early results indicate that the number of patients identified for risk assessment has increased dramatically and that the care of these patients is more efficient and likely more effective.

Clinical utility of a Web-enabled risk-assessment and clinical decision support program

“…2,3 Several computerized data-collection and risk-assessment programs have been developed to help combat these challenges. Examples include Health Heritage, 4 MyFamily, 5 Family Healthware, 6 HughesRiskApps, 7 and MeTree. 8 Studies of these and other nonelectronic risk-assessment aids have consistently shown the ability of such tools to increase the identification of individuals who meet guideline criteria for "increased" risk disease management strategies.…”

Oncology Lifeline - A Timeline Tool for the Interdisciplinary Management of Breast Cancer Patients in a Surgical Clinic

“…The implementation platform for the tool is the RiskApps software package developed by the collaboration between the University of Massachusetts Lowell and the Massachusetts General Hospital for identifying patients at high risk of developing breast cancer [5]. The RiskApps package is built to be consistent with a modular approach in developing niche solutions with international standards-based interfaces for compatibility [6].…”

Implementation of health risk assessments with family health history: barriers and benefits

“…Results regarding the HRA tool, MeTree, showed decreased overuse of high-risk services among average-risk individuals by 81% while increasing use among appropriate high-risk individuals (unpublished data, Lori Orlando, 2015). In another study, a significant increase in referrals to genetic services was seen with the implementation of a breast cancer risk assessment tool, Hughes RiskApps 46. Quereshi et al 43 showed significant improvements in smoking cessation rates with use of a FHH-focused HRA.…”