Kevin S.Hughes, MD, FACSCo-Director, Avon Comprehensive Breast Evaluation Center

Massachusetts General Hospital

SurgeonThe Newton-Wellesley Hospital Breast Center

Computer Solutions to Identify and Manage Women at High Risk

Reviews Report

Reviews suggestedManagement

Adds clinical information

Documents and Orders

Patient education

al materials

Clinical Decision Support

Patient enters data : Tablet PC

iPadWebsite

Clinical Decision Support

EHR

EHR

HughesRiskApps

Kshughes@Partners.org

www.HughesRiskApps.net

Demo

Our Goal

Find every mutation carrier for every

hereditary syndrome known to man before

disease occurs

Cancer Risk

Breast 63% 55%

Ovary 58% 30%

Breast 6%

Female

Male

BRCA1 BRCA2

BRCAPRO

BRCA1/2 Mutation carriers in the US

~1,000,000 carriers

~350,000 females 20 and older

n CarriersJewish

(1/40) 6,191,281 154,782

Not Jewish(1/350) 275,230,624 786,373

281,421,906 941,155

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

Family history

Multiple relatives affected

Young age at diagnosis

Multiple primary cancers

Unusual CancerMale breast cancer

BRCAPRO

Options for high risk

Prophylactic Oophorectomy

Screening

Chemoprevention

Options for high risk