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Can a Computer Counsel?

© Laura Ruth

Both your sister and your grandmother had breast cancer and you are scared to death about your risk of breast cancer. You have heard there is genetic testing available but are not really sure what the genetic testing will tell you. Although the sound, reaction, and discussion of a human genetic counselor about the subject of breast cancer genetic testing would be beneficial for learning about your risk, using a computer program to learn background or review information about breast cancer testing during a breast cancer genetic counseling session might be helpful.

Drs. Green and Fost have developed a CD-ROM entitled “Counseling by Computer: Breast Cancer Risk and Genetic Testing,” through the University of Wisconsin-Madison, Department of Medicine and Program in Medical Ethics. The CD-ROM covers three areas: (1) breast cancer, (2) heredity, and (3) genetic testing. The user learns about breast cancer, risk and probability, breast self-exams, and risk factors for breast cancer. The user can explore the different genetic, environmental, and reproductive factors for breast cancer. Having to work through three different scenarios of breast cancer risk highlight the different possibilities of getting breast cancer. The user will also learn all about the role of family history and breast cancer, genes and chromosomes, susceptibility genes, tumor suppression & Knudson’s two-hit hypothesis, mutations, and inheritance. The CD-ROM also presents a thorough discussion of positive, negative, and inconclusive genetic tests and insurance privacy issues.

There are a few areas of learning about breast cancer genetic testing, however, which are not covered on the CD-ROM. There is not enough information about the risk of ovarian cancer associated with breast cancer and ovarian cancer screening tests. Interpretation of a person’s pedigree is also weak. Discussion about the risk associated for breast cancer for a person of Ashkenazi Jewish ancestry is too limited. Lastly, the risk for contralateral breast cancer risk for a person with a previous history of breast cancer and who is a BRCA1 and BRCA2 mutation carrier is not addressed.

Outlook
A computer program which has information about a genetic test, such as breast cancer, can supplement the work of a genetic counselor by providing additional background information for the genetic counselor. “Counseling by Computer: Breast Cancer Risk and Genetic Testing” is currently being used in clinical trials at several medical sites: Hershey Medical Center, University of Pittsburgh, and MD Anderson Cancer Center.

Reference:

Software Review: “Counseling by Computer: Breast Cancer Risk and Genetic Testing,” Genetic Testing, 4(1), 2000, 43-44.

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