JOURNAL OF WOMEN'S HEALTHVolume 8, Number 1, 1999Mary Ann Liebert, Inc.

CD-ROM Review

Counseling by Computer: Breast Cancer Risk &Genetic Testing. Michael J. Green, M.D. (Penn-sylvania State University, Hershey) and NormanFost, M.D., M.P.H. (University of Wisconsin,Madison). 1998. Available from WisconsinAlumni Research Foundation, Attn: Mark G.Bloom, P.O. Box 7365, Madison, WI 53707-7365.Cost: $22.00 plus $3.00 S&H—Checks only, pay-able to the Foundation. This project is funded bygrants from the National Cancer Institute.

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The authors of this CD-ROM have compileda teaching tool for patients and medical pro-

fessionals who are interested in the basics ofbreast cancer risk and genetic testing. This a sub-ject of great interest at the present time due to therecent availability of BRCA1 and BRCA2 genetesting and, most recently, the new data con-

cerning tamoxifen chemoprevention.An overview of the CD-ROM as a teaching tool

in general and, specifically, of this breast cancerCD-ROM has been presented by the authors in re-cent publications. In the Journal ofCancer Education,for example, the authors address such criticisms ofthe computer-based teaching format as "patientsare not computer literate"; "a computer is cold andimpersonal"; "a computer cannot address a pa-tient's specific questions"; and "computers are notcost effective for patient education." The authors'responses to these criticisms are persuasive. Forthose who remain skeptical, I would simply sug-gest observing the schoolchildren of today. Com-puter learning may be difficult for many of us toaccept, but it is a daily occurrence in our schools.

Accuracy of informationThe CD-ROM is divided into three sections: 1)

General breast cancer concepts such as incidence,risk, breast self-exam, prevention, and treatment;2) hereditary breast cancer issues such as familyhistory, genes, specific genetic abnormalities as-sociated with breast cancer, and the associatedbreast risks; and 3) specific genetic testing withits advantages, disadvantages, possible results,

treatment options, confidentiality, and alterna-tives. There is a considerable amount of infor-mation that can be effectively covered by the user

in about 1 hour.Some information in the CD-ROM needs clar-

ification. In the breast cancer overview section,for example, the authors identify smoking as a

definitive risk for breast cancer. However, smok-ing is not generally considered one of the majorrisk factors for breast cancer, and neither the Na-tional Cancer Institute nor the American CancerSociety on their patient internet websites identifysmoking as a significant breast cancer risk factor.Also, there are some topics covered that shouldprobably be updated, even though the CD-ROMwas produced in 1998. Specifically, the area on

chemoprevention is brief; the user would proba-bly consider information such as tamoxifen pre-vention to be useful.

Overall, the material covered is very basic—thekind of information that both patients and med-ical professionals should find helpful.

QualityThe quality of the CD-ROM is good. The authors

have successfully combined interactive graphics,interface screens, and audio that results in a pro-gram that maintains the user's attention and guideshim or her through the material in a most effectivemanner. The user can at any time proceed forwardor backward between topics. There is also an indexand a review option that can be accessed easilyfrom the menu bar at the bottom of the screen.

UsefulnessThis CD-ROM will be very useful for both pa-

tients and medical professionals. It covers an area

of breast cancer, namely, genetics and genetic test-

ing, that requires additional time and some back-ground to understand. An excellent overview ofthis area is provided that should be very helpful,particularly for patients who are considering ad-ditional risk assessment and, possibly, genetictesting. Patients can review the CD in either a

physician's office or their own home setting. TheCD-ROM is now available for purchase, but the

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authors feel that in the future such informationshould be available over the internet.

In summary, the CD-ROM by Drs. Green andFost represents a very worthwhile effort to cover

a major emerging breast cancer topic.Reviewed by Joseph P. Crowe, M.D.

Director, Breast CenterThe Cleveland Clinic Foundation

Cleveland, Ohio

BIBLIOGRAPHY

Green MJ, Fost N. Who should provide geneticeducation prior to gene testing? Computersand other methods for improving patient un-

derstanding. Genetic Testing 1997;1:131.Green MJ, Fost N. An interactive computer pro-

gram for educating and counseling patientsabout genetic susceptibility to breast cancer. JCancer Educ 1997;12:204.