The use of ‘decision support’ computer software can significantly improve the management of patients concerned about their family history of breast and bowel cancer, according to a study published in the British Journal of Cancer* today (Tuesday).
In a trial funded by Cancer Research UK and the NHS, GPs in East Anglia were found to be more effective at referring patients with a family history of breast or bowel cancer when they used a new computer-based decision support system called GRAIDS (Genetic Risk Assessment on the Internet with Decision Support).
The GRAIDS system provides doctors with a user-friendly computer programme designed to calculate family cancer risks for individual patients. The programme uses existing data on cancer risks together with information given by the patient on their family history of cancer.
A total of 45 general practices in the East Anglia region took part in the trial. Twenty-three adopted the GRAIDS system, while the remaining 22 practices used current best practice, relying on the judgement of GPs to make referrals, aided by a paper copy of the regional referral guidelines and a 45-minute presentation on cancer genetics. Patients deemed at increased risk were then referred to the Eastern Regional Genetics Clinic based at Addenbrookes Hospital in Cambridge.
Compared with best practice, using the GRAIDS system both increased the number of patients referred by GPs to regional genetics specialists, and ensured that referrals more closely matched official referral guidelines.
General practices using GRAIDS referred 162 patients over the trial’s 12-month period, compared with 84 patients referred by those using current best practice.
Lead researcher Professor Jon Emery, currently based at the University of Western Australia, said: “Our study shows for the first time the value of software that assesses family history for general practice.
“The GRAIDS system resulted in significantly more referrals that were consistent with guidelines, for those with a family history of breast cancer and in cases whether there was a history of both breast cancer and colon cancer in the same family.”
The GRAIDS system also produced a higher proportion of referrals meeting the criteria for increased risk, as defined by the regional guidelines. For those referred with a family history of breast cancer, 93 per cent met the official referral guidelines for increased risk. For bowel cancer, the figure was 99 per cent while 95 per cent of patients referred with a family history of both met the guidelines.
This compares with figures of 73 per cent, 92 per cent and 79 per cent respectively for patients referred through best practice.
Patients referred by the GRAIDS system also reported feeling less anxious about their risk of cancer than those patients referred through current best practice.
As a result of this trial the Australian government is funding the development of a national electronic family history tool, based on the GRAIDS software, for use by GPs.
Dr Lesley Walker, director of cancer information at Cancer Research UK, which owns the British Journal of Cancer, said: “As we discover more about the genetic factors associated with cancer, GPs will be on the front line when it comes to providing advice and support to those with a history of the disease in their families, and reassuring those who may have overestimated their risk. Assessment software like GRAIDS will have a significant role to play, helping to detect those at increased risk and reassuring those who are not.”
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- Emery et al. British Journal of Cancer, Vol 97 Issue 4
British Journal of Cancer
The BJC’s mission is to encourage communication of the very best cancer research from laboratories and clinics in all countries. Broad coverage, its editorial independence and consistent high standards have made BJC one of the world’s premier general cancer journals. www.nature.com/bjc.
Breast cancer
- 44,000 new cases of breast cancer are diagnosed in the UK every year, causing more than 12,500 deaths annually.
- A woman with one affected first degree relative (mother or sister) has approximately double the risk of breast cancer of a woman with no family history of the disease; if two (or more) relatives are affected, her risk increases further.
- However, over 85% of women who have a close relative with breast cancer will never develop the disease, and more than 85% of women with breast cancer have no family history of it.
Bowel cancer
- 36,100 new cases of bowel cancer are diagnosed each year in the UK – 13 per cent of all cancers. It causes almost 16,100 deaths annually.
- People who have a first-degree relative with bowel cancer are at approximately twice the average risk, higher if the relative with the disease is young or if there is more than one first-degree relative affected. Patients who have previously been diagnosed with colon cancer have approximately four times the average risk of developing a new tumour.
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