Description of breast cancer risk program

The program assumes that there is a gene predisposing to breast cancer in addition to the BRCA genes. The woman's family history is used to calculate the likelihood of her carrying an adverse gene, which in turn affects her likelihood of developing breast cancer. The risks of developing breast cancer for the general population were taken from the national data rates for breast cancer in 1994. These rates are quite high and are higher than the risks described in most papers, however this may be because of the increase in breast cancer over the centuries.

The risk from family history (caused by the adverse genes) is modelled to fit the results in "Familial Breast and Ovarian Cancer: A Swedish Population-based Register Study, Anderson H et al., American Journal of Epidemiology 2000, 152: 1154-1163".

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Contact Details:

Prof. Jack Cuzick
Cancer Research UK Centre of Epidemiology, Mathematics and Statistics,
Wolfson Institute of Preventive Medicine,
Charterhouse Square,
London
EC1M 6BQ

email: riskevaluator@ems-trials.org

The program begins by opening the introduction screen. From this screen you can open files describing the program as well as going to the main evaluation screen. If you want to go directly to the evaluation screen the next time the program is run then you should tick the ‘Start from evaluation screen’ box.

The top part of the evaluation screen deals with personal information about the woman - her age at menarche, parity etc. The bottom part of the screen deals with her family history. The enclosed PowerPoint presentation gives details on some aspects of the program. The picture in the form gives the family history in the form of a pedigree diagram.

When entering details about family members if she developed breast cancer then the age at breast cancer should be put in the relevant age box, otherwise her current age should be used (or the age at which she died if applicable). If she developed ovarian cancer then a box is activated which asks for details at which age it occurred. Similarly if she developed bilateral breast cancer then a box is activated which asks for the age at which breast cancer developed in the second breast. If age is not known then ‘?’ should be entered in the age box. If it is not known whether a relative developed breast cancer then ‘u’ should be typed in the age box to represent no information. If the woman has an affected niece in the family then the affected niece button should be pressed to enter the details.

The effects of weight were only assumed to affect risk once the menopause is reached. If the height is not known then the BMI cannot be calculated and so weight is ignored. The risk from height is also assumed to be independent from the BMI. If you prefer to use imperial measurements for height and weight then the imperial radio button should be clicked.

Typing '?' represents missing data. If nothing is known about parity then the unknown radio button should be pressed. Similarly if nothing is known about the woman’s menopause the no information radio button should be pressed. If the woman has had atypical hyperplasia, LCIS or some other benign breast disease then the appropriate box should be ticked.

If genetic testing has taken place within the family, then the ‘Genetic Testing’ button can be pressed to give a form on which to enter the results. Finally to get back to the introduction screen the ‘Show start up screen’ button should be pressed.

Changes to version 5

• Added the buttons “Affected cousins” and “Half sisters”. These activate dialog boxes, which ask for information about cousins and half sisters respectively.

• Added a check box for Ashkenazi inheritance to be ticked for someone from an Ashkenazi Jewish family.

Changes to version 5.1 

Added “Copy to Clipboard” option for print preview screen so that user can paste results into Word or PowerPoint.

Changes to version 6

The program now allows you to save patients’ details. Also more information about the woman is given in the print preview screen.

A number of other options are available in the toolbar. These are

Add – Add a patient to the file.
Del – Remove a patient from the file.
Risk – Create a file giving risks for the patient in 10 years time.
Sort – Sort the patients in alphabetical order
Find – Find a patient (from the id code)

Format of text file used for saving patients’ details (only needs to be known if using the program for batch input)

Version number (in this case “v6”)

number of patients

For each patient

patient_id    age    menarche    parous (2 not known)   age_at_first_child
menopause_status (3 not known)   menopause_age    height (in m)    weight
(in kg)
hyperplasia(without atypia)    atypical_hyperplasia    LCIS
ovarian_status    age_at_ovarian_cancer    ashkenazi_inheritance
hrt_use    hrt_type    hrt_length    intended_use_length    hrt_last_use
genetic_test    father_genetic_test
mother_affected_status    mother_bilateral_status    mother_ovarian_status
mother_age    mother_bilateral_age    mother_ovarian_age
mother_genetic_test_result
no_of_sisters    for each sister defined (same seven variables as defined
for mother (affected_status...genetic_test_result))
paternal_gran variables (7 variables as before)
maternal_gran variables
no_of_paternal_aunts    variables for each maternal aunt
no_of_maternal_aunts    variables for each paternal aunt
no_of_daughters    variables for each daughter
no_of_nieces (= number of sisters + number of brothers with daughters)
for each sister: no_of_daughters    variables for each daughter
no_of_paternal_half_sisters    variables for each half_sister
no_of  maternal_half_sisters    variables for each half sister
no_of_paternal_aunts    for each paternal aunt: number of daughters
variables for each daughter
no_of_maternal_aunts    for each maternal aunt number of daughters
variables for each daughter
no_of_paternal_brothers_with_daughters    for each paternal brother: number
of daughters    variables for each daughter
no_of_maternal_brothers_with_daughters    for each maternal brother: number
of daughters    variables for each daughter

For missing data -99 should be generally be used.

Special cases

The patient_id is a string variable containing the code for the patient
(underscores should be used instead of spaces if necessary).
parous - 0 nulliparous, 1 parous, 2 status not known.
menopausal_status - 0 premenopausal, 1 perimenopausal, 2 postmenopausal, 3
status not known
hrt_use -  0 never,  1  use >5 years ago, 2  use <5 years ago, 3  current
user
hrt_type -  0 oestrogen only,  1 combined (relevant for hrt users, but 1 by
default)
hrt_length - how long someone has been using hrt in the past (relevant for
hrt users, 0 by default)
intended use length - how long someone intends using hrt in the future
(relevant for current users, 0 by default)

For each relative

affected status - 0 no breast cancer, 1 breast cancer
bilateral_status - 0 no bilateral breast cancer, 1 bilateral breast cancer
ovarian_status - 0 no ovarian cancer, 1 ovarian cancer
age - age of relative
bilateral_age - age at bilateral cancer (relevant if woman had bilateral
breast cancer, -99 default)
ovarian_age - age at ovarian cancer (relevant if woman had ovarian
cancer, -99 default)
genetic test - 0  no test,  1  no BRCA gene found,   2  BRCA1 gene found,  3
BRCA2 gene found