title: iPrevent®: a tailored, web-based, decision support tool for breast cancer risk assessment and management.
abstract: We aimed to develop a user-centered, web-based, decision support tool for breast cancer risk assessment and personalized risk management. Using a novel model choice algorithm, iPrevent(®) selects one of two validated breast cancer risk estimation models (IBIS or BOADICEA), based on risk factor data entered by the user. Resulting risk estimates are presented in simple language and graphic formats for easy comprehension. iPrevent(®) then presents risk-adapted, evidence-based, guideline-endorsed management options. Development was an iterative process with regular feedback from multidisciplinary experts and consumers. To verify iPrevent(®), risk factor data for 127 cases derived from the Australian Breast Cancer Family Study were entered into iPrevent(®), IBIS (v7.02), and BOADICEA (v3.0). Consistency of the model chosen by iPrevent(®) (i.e., IBIS or BOADICEA) with the programmed iPrevent(®) model choice algorithm was assessed. Estimated breast cancer risks from iPrevent(®) were compared with those attained directly from the chosen risk assessment model (IBIS or BOADICEA). Risk management interventions displayed by iPrevent(®) were assessed for appropriateness. Risk estimation model choice was 100 % consistent with the programmed iPrevent(®) logic. Discrepant 10-year and residual lifetime risk estimates of >1 % were found for 1 and 4 cases, respectively, none was clinically significant (maximal variation 1.4 %). Risk management interventions suggested by iPrevent(®) were 100 % appropriate. iPrevent(®) successfully integrates the IBIS and BOADICEA risk assessment models into a decision support tool that provides evidence-based, risk-adapted risk management advice. This may help to facilitate precision breast cancer prevention discussions between women and their healthcare providers.
authors.affiliation: Division of Cancer Medicine, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St., Melbourne, VIC, Australia.|The Greater Green Triangle Clinical School, Deakin University School of Medicine, Warrnambool, Australia.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Collins
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Bickerstaffe
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors.forename: Thilina
authors.initials: T
authors.lastname: Ranaweera
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Maddumarachchi
authors.affiliation: Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Keogh
authors.affiliation: Department of General Practice, The University of Melbourne, Melbourne, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Emery
authors.affiliation: The Breast Service, Royal Melbourne and Royal Women's Hospital, Melbourne, Australia.|Department of Surgery, The University of Melbourne, Melbourne, Australia.
authors.forename: G Bruce
authors.initials: GB
authors.lastname: Mann
authors.affiliation: Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED) and The Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Sydney, Australia.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Butow
authors.affiliation: Division of Cancer Medicine, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St., Melbourne, VIC, Australia.
authors.forename: Prue
authors.initials: P
authors.lastname: Weideman
authors.affiliation: Division of Cancer Medicine, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St., Melbourne, VIC, Australia.|Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Steel
authors.affiliation: Division of Cancer Medicine, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St., Melbourne, VIC, Australia.|Department of Medicine, The University of Melbourne, Melbourne, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Trainer
authors.affiliation: Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Mathias
authors.initials: M
authors.lastname: Bressel
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
authors.forename: John L
authors.initials: JL
authors.lastname: Hopper
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.affiliation: Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Antonis C
authors.initials: AC
authors.lastname: Antoniou
authors.affiliation: Division of Cancer Medicine, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St., Melbourne, VIC, Australia. kelly.phillips@petermac.org.|Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia. kelly.phillips@petermac.org.|Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia. kelly.phillips@petermac.org.|Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia. kelly.phillips@petermac.org.
authors.forename: Kelly-Anne
authors.initials: KA
authors.lastname: Phillips
mesh_terms: D000465:Algorithms; D001315:Australia; D001943:Breast Neoplasms / Q000517:prevention & control*; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D015233:Models, Statistical; D057285:Precision Medicine; D018570:Risk Assessment; D012307:Risk Factors; D014584:User-Computer Interface
keywords: BRCA1; Breast cancer; Chemoprevention; Decision support; Risk