Self-administered, web-based screening of family history of cancer as a method to select appropriate patients for genetic assessment.
Authors: Acheson LS , Lynn A , Wiesner GL 
Published: December 2010

Abstract
Abstract #1096
Background: The US Preventive Services Task Force (USPSTF) recommends that women with family histories suggesting increased risk of hereditary breast-ovarian cancer (HBOC) be referred to genetic counseling. Feasible methods for family history risk assessment are needed in order to implement this guideline. This study is conducted to assess the feasibility of using a computer-assisted family history tool to identify appropriate candidates for genetics referral among women seen in a multispecialty breast diagnostic center. Material and Methods: The Web-based Genetic Risk Easy Assessment Tool (GREAT) uses a validated, self-administered questionnaire to collect personal and family history of cancer. It connects with CancerGene to calculate breast cancer risks by Gail, Claus, and BRCA-PRO models and BRCA mutation probabilities. Validated algorithms in GREAT identify increased risk of HBOC according to USPSTF criteria, modified to include women with breast cancer. It provides a personalized report including cancer risk and prevention messages and a family tree. We invited consecutive women obtaining mammograms or consultations at the UH Breast Center to use the GREAT and obtained users' immediate feedback about the Website and personal report. Each user's responses were evaluated by genetics professionals to determine whether genetics referral would be indicated, and whether the woman herself or a living relative would be appropriate for genetic cancer susceptibility testing. Preliminary Results (participant enrollment is ongoing): 2065 women, mean age 57, were invited in the first 5 months of 2008. 22% had breast or ovarian cancer, 30% had a relative with breast or ovarian cancer, and 48% had no family or personal history. 194 women returned questionnaires to decline participation (mean age 56, 43% African-American); 37% did not have a computer or internet access, and 26% were concerned about privacy and internet security. 105 women consented and 67 so far had completed the GREAT (mean age 60, 16% African-American, 22% with a history of breast cancer). 28% of GREAT users received reports indicating increased risk for HBOC; all were considered appropriate for genetic counseling. &gt;90% of users found the website easy to navigate, the questionnaire and personal report easy to understand, and the time taken not too long; none found the process upsetting. Most participants planned to talk with family members and show the report to relatives. Discussion: A self-selected, higher-risk group of women found the web-based GREAT an acceptable means of personal and familial cancer risk assessment in the context of a visit to the Breast Center. Lack of internet access and concerns about internet security posed barriers for some would-be participants. If analyses confirm the sensitivity and specificity of risk algorithms, providing access to this tool at the time of mammography may increase the feasibility of identifying and referring women for genetic consultation regarding hereditary breast-ovarian cancer susceptibility.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1096.