NEW YORK (Reuters Health) - When it comes to figuring out who is most at risk of developing breast cancer, computers may do as good a job as experienced human genetic counselors, new study findings suggest.

Computers were as accurate as counselors at determining which women might be likely to have inherited mutations of the so-called breast cancer genes, based on the women's family histories, according to the report published in the June 5th issue of the Journal of the National Cancer Institute.

A woman who inherits a mutation of the BRCA1 or BRCA2 gene has a 35% to 85% chance of developing breast cancer at some point in her life, noted the study's lead author, Dr. David Euhus, a researcher at the University of Texas Southwestern Medical Center. She is also at high risk of developing ovarian cancer, he added.

Because cancer risk can be greatly reduced by surgical removal of the ovaries and/or the breasts, women with a family history of breast or ovarian cancer often want to know whether they inherited these genetic mutations.

But genetic testing for cancer susceptibility can be costly and sometimes the results can be ambiguous when it comes to decisions about patient care, Euhus explained. So "careful patient selection is required prior to testing," he said.

In the new study, Euhus and his colleagues gave cancer data on 148 families to eight genetic counselors and the computer. Computer and counselors were told how many family members had cancer and at what age they developed the disease.

Machine and man fared almost equally well, with both computer and counselors identifying at-risk patients more than 90% of the time, the investigators found.

This doesn't mean that computers will put genetic counselors out of work, Euhus said in an interview with Reuters Health. "There are way too many human factors involved in this type of counseling," he added. "Mutation prediction is only one small part of what the risk counselor does. But, I think inexperienced counselors should use the computer, and even trust the computer, until they build up a track record of their own."

Euhus also thinks that the computer can be used as a "pre-screener."

"Every patient who attends the UT Southwestern Center for Breast Care has their family history information run through the computer before first seeing the doctor," he said. "This makes it possible to intelligently discuss referrals for general risk counseling or genetic testing.

"More experienced genetic counselors will draw extended pedigrees and formulate an opinion concerning mutation probability based on these. But they will also double check with the computer, because, occasionally, we're surprised to find that a family history that appears innocuous on first glance is actually associated with a fairly high probability of mutation" by the computer.

SOURCE: Journal of the National Cancer Institute 2002;94:844-851.

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