Patient Centric App Review Series

Goals of app review:

  • To determine if BRCAmanager can be recommended for patients who are concerned about their risk of breast cancer
  • To determine if healthcare providers can utilize the app for educating patients regarding BRCA testing and breast health.

Introduction:
Breast cancer is the second most common neoplastic cause of death in women, behind lung cancer. In 2010 15% of cancer deaths in women in the US were from breast cancer[1]. This app was developed by Geference to calculate breast cancer risk using both a genetic analysis as well as the Gail model.

It also gives detailed instructions on self-breast exam (SBE) as well as offering the opportunity to engage with other users as a community. Geference is personal genomics company based in Seoul, South Korea.

Unfortunately, it is apparent from the writing and language in the app that this was translated by an individual well-acquainted with the English language however there are misspellings and grammatical errors spread throughout the app.

After signing up the user is taken to the main screen where she is invited to start a breast-self examination or check on any community responses to messages. There is also a “News” area documenting changes to the app such as the latest update. Along the bottom are buttons to bring up the risk calculator, self exam, community and information pages.

The risk calculator appears to be solely based on the GAIL model (not using the genetic model commented on in the apps iTunes’ description) and it is not the complete GAIL model as some questions are omitted[2]. This omission would account for the ten year risk to be off by 3.5% (probably not statistically significant).

The breast self exam portion of the app has a very detailed video that includes a brief explanation of the anatomy. It invites the user to enter the last menstrual cycle ending in order to determine the optimal time to check the breast or post-menopausal status.

Next, the user can “start exam” where the process is delineated with illustrations and ends with the opportunity to input any abnormalities such as lumps, discharge, nipple inversion, radical change in breast size or warmth. If at least ONE of these are positive the programs tells the user that they “can” consult a physician.

The “community” button allows the user to enter comments that are seen by other members of this site and can engender discussion. There is an information page with a discussion of the purpose of the app and how the user can benefit from it. This is where the worst grammatical errors are obvious, enough to impact understanding of how the app is beneficial.

Healthcare goals of app:
The purpose of this app is to increase awareness of the GAIL model and risk assessment. Although this is a “personal genomics company” the app did not address genetic testing anywhere. The app also has well-detailed instructions and states “70% of breast cancers are found by self-exam” and “98% 5-year survival rate for early detected breast cancer patients”. (This statistic is also quoted by the National Breast Cancer Foundation, Inc).

Evidence to support goals:
There are multiple studies suggesting that there is no benefit on breast cancer survival from SBE [3,4] and the US Preventive Task Force has determined there is insufficient evidence to recommend routine SBE. The American Cancer Society recommends that providers discuss the pros and cons with all women over 20 so that patients can make an informed choice regarding its usage.

The Gail model of breast cancer risk is a validated tool(5) and is strongly recommended for use with a healthcare provider. It has not been validated for use outside of the US[6].

Details of app: 

App Reviewed: BRCAmanager (version 1.1)
Last Updated: Mar 28, 2012
Compatibility: iPad–iPhone app is slightly different and called BRCA manager mobile
Requires: iOS 3.2 or later required
Reviewed on: iPad/iPhone

Price:

  • Free

Likes:

  • Links across devices
  • Contains an excellent breast self-exam video
  • Provides detailed breast-self exam illustrations as well
  • Easy UI

Dislikes:

  • Examination is misspelled on the entry page.
  • Breast exam “trends” witch graphs abnormalities is superfluous and of no practical use
  • Grammatical errors and misspellings are scattered across the app
  • Community “site” did not appear to be monitored by the app company
  • Despite the name this reviewer could find no mention of BRCA testing or its role in breast cancer risk

What providers would benefit from app?

  • Ob/Gyn
  • Oncologists
  • Primary Care Physicians

What patient would benefit from app?

  • Patients who are concerned about their breast cancer risk
  • Patients that wish to have a detailed explanation of how to use the SBE (self breast exam)

Conclusions:

  • BRCAmanager contains a Gail model breast cancer risk tool, a SBE illustration and reminder to perform the exam, a community site for users and a brief educational discussion
  • Pros-the SBE area is very well done and the Gail calculator appears to be reasonably accurate when tested by the user
  • Cons-there is no evidence that SBE reduces mortality in breast cancer patients and some data suggests it may increase anxiety and procedures due to the finding of benign nodules. The app has grammatical English errors that are distracting and make the informational area difficult to understand.
  • The app had an easy UI and anyone with the savvy of using a smartphone should have no issues interacting and inputting data with it.

Bottom Line:
Providers and Patients who want a detailed explanation of how to do the SBE would find this app very useful. Providers should use the National Cancer Institute site for a more accurate and up-to-date Gail risk tool. There is no mention of genomic risk or BRCA testing at this point in the app and the grammatical errors are off-putting to an English speaker.

The reviewer does not recommend the app for use in clinical practice.

iTunes iPad link
iTunes iPhone link

References:
1. HRSA website. Womens Health USA 2010/Cancer. URL:http://mchb.hrsa.gov/whusa10/hstat/hi/pages/213c.html. Accessed: 2012-07-22. (Archived by WebCite® at http://www.webcitation.org/69LlgMjT4)
2. National Cancer Institute Webcite, GAIL model Breast Cancer Risk Assessment tool http://www.cancer.gov/bcrisktool/
3. Holmberg L, Ekbom A, Calle E, et al. Breast cancer mortality in relation to self-reported use of breast
self-examination. A cohort study of 450,000 women. Breast Cancer Res Treat 1997;43 137-40
4. Thomas DB, et al. Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst. 2002 Oct 2;94(19):1445-57.
5. Rockhill B, et al. Validation of the Gail et al. Model of Breast Cancer Risk Prediction and Implications for Chemoprevention. URL:http://jnci.oxfordjournals.org/content/93/5/358.abstract?ijkey=84885963202c758601da39788bfcfb36e1159472&keytype2=tf_ipsecsha. Accessed: 2012-07-22. (Archived by WebCite® at http://www.webcitation.org/69LsxRBLA)
6. Decarli A et al. Gail Model for Prediction of Absolute Risk of Invasive Breast Cancer: Independent Evaluation in the Florence–European Prospective Investigation Into Cancer and Nutrition Cohort JNCI J Natl Cancer Inst (6 December 2006) 98 (23): 1686-1693.doi: 10.1093/jnci/djj463
Disclaimer:
This post does not establish, nor is it intended to establish, a patient physician relationship with anyone. It does not substitute for professional advice, and does not substitute for an in-person evaluation with your health care provider. It does not provide the definitive statement on the subject addressed. Before using these apps please consult with your own physician or health care provider as to the apps validity and accuracy as this post is not intended to affirm the validity or accuracy of the apps in question. The app(s) mentioned in this post should not be used without discussing the app first with your health care provider.