1. Computer Solutions to Identify and Manage Women at High Risk
Kevin S.Hughes, MD, FACS
Co-Director, Avon Comprehensive Breast Evaluation Center
Massachusetts General Hospital
Surgeon
The Newton-Wellesley Hospital Breast Center

2. EHR EHR Patient enters data : Tablet PC iPad Website
Patient educational materials
Clinical Decision Support
EHR
Reviews Report
Reviews suggested
Management
Adds clinical information
Clinical Decision Support
Documents and Orders
EHR

3. HughesRiskApps

4. Demo

5. Our Goal
Find every mutation carrier for every hereditary syndrome known to man before disease occurs

6. Cancer Risk BRCA1 BRCA2 Breast 63% 55% Ovary 58% 30% Breast 6% BRCAPROF e m a l M
Breast 63% %
Ovary % 30%
Breast %
BRCAPRO

7. BRCA1/2 Mutation carriers in the US
Jewish
(1/40)
6,191,281
154,782
Not Jewish
(1/350)
275,230,624
786,373
281,421,906
941,155
~1,000,000 carriers
~350,000 females 20 and older

8. 15 years of genetic testing
BRCA tests to date
~500,000
Assume 10% positive
50,000 BRCA1/2 carriers found
Assume most tested patients had cancer
95 to 99% of unaffected carriers not tested
Likely the best of any adult hereditary syndrome

9. Family history Multiple relatives affected Young age at diagnosis
Multiple primary cancers
Unusual Cancer
Male breast cancer

10. BRCAPRO

11. Options for high risk

12. Prophylactic Oophorectomy
Options for high risk
Chemoprevention
Prophylactic Oophorectomy
Screening