Web-based tool to assess breast cancer risk for women presenting to a gynecologic oncology visit

Objectives: Approximately 40,000 women die from breast cancer each year in the United States, highlighting the importance of identifying high-risk women prior to breast cancer development. Risk models exist, including the Tyrer-Cusick (TC) model but have not been widely implemented due to the time required to perform the risk assessment and interpret results. We aim to report our experience with a web-based application (WBA) to complete the TC model for women prior to a scheduled gynecologic oncology clinic visit. Methods: All patients scheduled for a gynecologic oncology new patient appointment between 9/2020-9/2021 were offered enrollment in an institutional review board-approved prospective trial. Patients were randomized to standard of care gynecologic oncology visit versus utilization of a WBA completed either at home or in the office prior to the appointment (randomized 1:1:1). The WBA collects personal and family health history and utilizes this information to generate a TC score. As part of the trial protocol, all women with a TC score reflecting a lifetime risk of breast cancer ≥ 20% were referred to the institution's high risk breast clinic which provides counseling on genetic testing, breast screening and breast cancer prevention. The WBA also generated additional information on personal and family cancer, the results of which are reported separately. Results: Sixty-six patients were randomized to utilization of the WBA which included completion of the TC model. Median patient age was 60 (range 22-88). Twenty-six patients (39.4%) did not complete the model for the following reasons: 13 (50%) were not able to access the application, 11 (42.3%) did not answer all required questions and 4 (15.4%) were ineligible due to prior breast cancer. Forty patients (60.6%) successfully completed the TC model and among those patients, 6 (15%) had a significantly elevated lifetime breast cancer risk score (defined as ≥ 20%), all of whom were referred to a high risk breast clinic. Conclusions: The COVID-19 pandemic has pressed the healthcare system to better utilize technology to provide safe and equitable medical care. A WBA for collection of personal and family health history and generation of cancer risk models completed prior to the physician appointment is an exciting application of such technology. When piloted in a gynecologic oncology practice, 60.6% of patients were able to complete the risk model and 15% of these patients were found to have a significantly elevated breast cancer risk warranting follow-up care.