Breast Cancer Institute NSW

Overview

SeeMyRisk.com | Online Breast Cancer Risk Calculator

The Westmead Breast Cancer Institute (BCI NSW) has been in operation since 1995 and is committed to delivering the best possible information, advice, treatment and care to patients with breast cancer. The BCI NSW provides screening, diagnosis, treatment and care by expert teams with a dedicated focus on world-class research, education and innovation.

"Breast cancer is the most common invasive cancer among Australian women. Over thirty-five women are diagnosed with breast cancer today and every day", commented Professor John Boyages, Executive Director of the Westmead Breast Cancer Institute.

The Solution

"There are many myths about the risks of breast cancer, both in the lay press and also amongst medical professionals. The often quoted risk of '1 in 8 women will develop breast cancer' is often over amplified. This figure implies a lifetime risk, whereas many women have already lived much of their life and only commenced worrying about breast cancer when they see their friends develop breast cancer in their 40s and 50s", says Professor John Boyages.

With support from Microsoft Australia and the Sydney West Area Health Service (SWAHS), the BCI NSW engaged Readify to develop an online interactive tool which allows healthcare professionals and members of the public to produce an estimate of a woman's personal risk of developing breast cancer during their lifetime. SeeMyRisk.com was the solution Readify developed. SeeMyRisk.com is a simple to use application that has been designed to potentially save lives and reduce severity of breast cancer through early detection. The application provides a more accurate prediction of breast cancer risk using a groundbreaking mathematical formula based on worldwide studies. The estimates are produced using the results of extensive research into core factors that can influence or contribute to a woman's chances of developing the disease, including demographics, family history and the use of Hormone Replacement Therapy (HRT).

"This world first calculator combines age, county of residence, the use of HRT and the presence or absence of a family history of breast cancer to work out a risk for an individual woman", says Boyages.

The information and formulas that provide the risk estimate are contained in a series of complex Microsoft Excel spreadsheets that was developed by Professor John Boyages, Nathan Coombs and Richard Taylor and can determine a woman's risk of developing breast cancer across several countries and for women of different ages. The risk was defined and calculated for a five year, ten year and lifetime period (up to the age of eighty) and plans are underway to expand the number of countries and different cancers applicable for this calculator.

"This calculator allows women, in consultation with a general practitioner, to determine their real risk level in developing breast cancer", Boyages added.

These spreadsheets have been developed over time by the NSW BCI and incorporate the results data from up to seven medical trials and study findings. They are maintained and updated by a few key individuals within the NSW BCI on a regular basis.

The online application itself consists of a Windows Presentation Foundation (WPF) XBAP application and a series of supporting ASP.NET web-services. The web-services allow the application to retrieve the latest set of reference data in an XML format from the hosting web server. The application contains a reference to an assembly that provides the same calculations that are present in the various Excel spreadsheets. The combination of the reference data and calculation assembly allows the application to provide the risk calculation feature to users.

In order to keep the reference data used by the application up to date on the hosting web server, an add-in for Excel was developed using Visual Studio Tools for Office (VSTO) 2007. This add-in takes the reference data stored in the Excel spreadsheets and converts it to an XML file in a format that the SeeMyRisk.com web-services and application can use. This file can then be uploaded to the hosting web-server via conventional means where it is immediately available to the application.

What makes SeeMyRisk.com unique?

SeeMyRisk.com is unique in a number of ways. Firstly, the application was developed in conjunction with leading researchers in the field of breast cancer. Secondly, SeeMyRisk.com features an immersive and rich WPF user interface. The advanced features of WPF have been leveraged to provide a fluid, intuitive and elegant experience for users utilising subtle animations, colour selections and interaction feedback. These elements work together in making the application appear sensitive to its intended purpose as well as comfortable for the user. The interaction is also displayed in real-time, so that if a user adjusts their input factors they can see how the calculated risk is affected immediately. This makes it simple for the user to experiment with various "what if" scenarios, particularly with relation to their family history and use of HRT.

Thirdly, the reference data used by SeeMyRisk.com is subjected to rigorous validation through a unique automated testing approach in the Excel add-in component of the solution. The goal is to ensure that the results of the calculation performed by the server are identical to the results of the complex Excel spreadsheet. The innovative approach of building a testing framework within the solution itself made the validation possible.

How is SeeMyRisk.com Innovative?

The SeeMyRisk.com application has been well recognised as a fantastic user experience and was exclusively highlighted by Microsoft's own User Experience Evangelist, Shane Morris at Remix 2007.

As mentioned previously, one of the major innovations of the SeeMyRisk.com solution is its use of a rich WPF user interface for the online calculator. An earlier version of the calculator was developed using traditional web-based forms in ASP.NET. While the calculator was functional, the way in which the information could be gathered and the result that was displayed, was limited by the intrinsic nature of the web. Factors first had to be entered into a web form by the user, with limited immediate feedback, followed by the user then clicking on a "submit" button in order to perform the risk calculation to display the results. As the form was "posted back" to the web server each time the user clicked the submit button, there was a time delay and thus evident disconnect between the users unique factors and the risk result presented. This approach also made it very time consuming and repetitive for the user to experiment with different input factor values for the purposes of "what-if" scenarios.

Utilising WPF for the calculator component enabled the solution to introduce paradigms of rich interface design all in real time, including immediate interaction feedback, input validation and assistance, and alternate display models for the calculated results. User interaction is highlighted through subtle animations of the various user interface elements, while input factors' effects on the calculated risk is highlighted through on-screen transitions that visually link a user's selections with the displayed risk result.

Testing the validity of both the reference data and the calculation was critical. The testing framework used by the VSTO application enables regular updates of the reference data in a safe and user-friendly way. Using an automated testing framework also helped in building confidence with the researchers over the calculations performed by the software.

The Technology

SeeMyRisk.com relies heavily on advanced Office Development techniques, specifically Visual Studio tools for Microsoft Office, which was an essential component of the solution creation process. In addition, the ability for Office applications such as Excel 2007 to be integrated with leading edge technologies such as WPF, make the Office system a fantastic platform for business solutions.

The core feature of SeeMyRisk.com is to compute the risk of developing breast cancer. The initial model developed by researchers used a complex set of formulas spread across sixteen Microsoft Excel spreadsheets. The challenge was to produce a versatile .Net component that would replicate the same calculations. This component is used by the web site to calculate risks in real time. The algorithm relies on a set of statistical tables called 'reference data'.

When a new scientific study is published, it may be necessary to update some of the reference data. This is usually performed in the Microsoft Excel spreadsheet by the Breast Cancer research team.

Once the new set of data has been validated, the Excel VSTO application can generate, on demand, thousands of virtual women's profiles, automatically compute their breast cancer risk with both methods, and check that 100% of them match. Once this validation passes, the user is allowed to upload the new set of reference data. This greatly reduces the risks of uploading incorrect reference data. Details of all the generated profiles (with their calculated breast cancer risk) are available in the Excel spreadsheet.

The Benefits

SeeMyRisk.com - Creating an Exceptional Experience for Customers

The major advantage of SeeMyRisk.com from a user perspective is that it provides users with a clear and fast indication of their likely chance of developing breast cancer in both the immediate and long-term future. The SeeMyRisk.com solution features an immersive and rich WPF user interface. The advanced features of WPF have been leveraged to provide a fluid, intuitive and elegant experience for users utilising subtle animations, colour selections and interaction feedback. These elements work together in making the application appear sensitive to its intended purpose as well as comfortable for the user. The interaction is also displayed in real-time, so that if a user adjusts their input factors they can see how the calculated risk is affected immediately. This makes it simple for the user to experiment with various "what if" scenarios, particularly with relation to their family history and use of HRT.

Also, the reference data used by SeeMyRisk.com is subjected to rigorous validation through a unique automated testing approach in the Excel 'add-in' component of the solution. The goal is to ensure that the results of the calculation performed by the server are identical to the results of the complex Excel spreadsheet. The innovative approach of building a testing framework within the solution itself made the validation possible. As the application was developed in conjunction with leading researchers in the field of breast cancer, it also has a proven high level of accuracy and credibility. The user experience is enhanced when results are valid and reliable.

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For More Information

To demonstrate evidence that SeeMyRisk.com is a truly exceptional application, experience it yourself at http://www.seemyrisk.com/.

For more information about Readify services, call +61 3 9600 2339 or 1300 666 274 (within Australia) or visit the website at http://www.readify.net/.