By Barbara Boughton

Both breast cancer and melanoma run in my family, so I’ve always been worried about getting these diseases. My mother also died from breast cancer, and my aunt has had the disease, so assessing my risk is particularly vital for me. That’s what drove me to try to assess my cancer risk on several websites one night.

As I cruised around the web, I found that two of the most reliable and informative sites for assessing cancer risk are run by the National Cancer Institute and Harvard Center for Cancer Prevention.

At the NCI website, I took a test called the Breast Cancer Risk Assessment Tool. After answering seven simple questions about my reproductive, medical and family history, I got my answer. My risk for breast cancer was above average but—to my surprise—not extremely higher than normal. I breathed a sigh of relief.

At the cancer risk assessment website run by Harvard, however, I found to my chagrin that I had a “very much above average” risk for melanoma. My blistering childhood sunburns and my family history increased my risk, but I could lessen it by wearing sunscreen lotion every day, the site told me.

The Harvard and NCI sites provided me with important information, just as they do for thousands throughout the United States. The Harvard site has had more than 112 million hits since it debuted in 2000. The websites are helpful because they can open the door to accurate information about cancer risk—even for those who live in remote areas, and don’t have access to regular medical care.

“Websites like ours provide real education about cancer risk. And they describe steps one can take to prevent cancer,” says Worta McCaskill-Stevens, program director at the NCI. Though there are important cautions for using these sites—they do not always predict risk accurately for those who have already had cancer or have a genetic mutation, and should only be used in consultation with a doctor—cancer experts say they are an important step forward.

“These websites are a valuable asset in providing information about cancer risk, a relatively new field. We hope that they will encourage people to get more diagnostic procedures, such as mammograms and colonoscopies that can catch cancer early,” says LaMar McGinnis, MD, senior medical consultant at the American Cancer Society, and medical director of Eberhart Medical Center in Atlanta.

The NCI site (bcra.nci.nih.gov/brc/) is an interactive tool originally developed to calculate risk for women enrolled in the Breast Cancer Prevention Trial, a large study on preventing breast cancer. At the site, a woman answers questions about her reproductive and birth history, family history of breast cancer and her personal history of breast biopsies. At the end of the test, the woman receives two numbers—one showing her risk for getting breast cancer in five years, and the other revealing her chance of breast cancer up to age 90. These numbers are explained and compared to those for an average woman of the same age and to the risk of women involved in the Breast Cancer Prevention Trial. In this trial, the anti-estrogen drug, Nolvadex® (tamoxifen) was evaluated against placebo in high-risk women.

The NCI breast cancer risk assessment site provides a wealth of detail about the risk factors for breast cancer, preventive breast cancer medication and clinical trials testing medicines that may help decrease breast cancer risk.

There are also links to other sites that provide information about breast cancer research and genetic counseling and testing. At these sites, you can find names and contact information for genetic counselors and clinical trials testing methods to prevent cancer.

Yet experts like Dr. McGinnis caution that consumers who use the breast cancer risk assessment tool should confer with their physician, so that they don’t misunderstand the results. “When you don’t have an interface with a health professional, there’s an opportunity for misinterpretation. And that can be a hazard, ” Dr. McGinnis says.

The Harvard site, called Your Cancer Risk (www.yourcancerrisk.harvard.edu), estimates risk for 12 different types of cancer. It is based on a review of scientific evidence on preventing cancer performed by the faculty of the Harvard School of Public Health. After choosing the test you want to take, you’ll answer a few questions about your personal history of cancer, your family history, your medical history and your lifestyle habits. The questions vary, depending on the type of cancer in which you’re interested. The breast cancer questionnaire asks about your intake of vegetables and alcohol, for instance, while the melanoma questionnaire asks about your sunburn history and if you’ve taken immunosuppressive drugs.

The test takes only a few minutes. At the end, you’ll get a risk assessment from low to very much above average. The site provides detailed information about what you can do to make your risk drop, and what you are doing right to keep your risk low. The breast cancer questionnaire, for instance, cautioned me to eat more vegetables per day, but congratulated me for drinking less than one alcoholic drink per day. It then gave me seven tips for incorporating vegetables into my meals.

“One of our goals is to get people to understand the message that lifestyle changes can lower your risk of cancer,” says Graham Colditz, PhD, professor of medicine at Harvard Medical School, and one of the developers of the site.
As for me, the information I received at the Harvard and NCI websites convinced me that I should wear sunscreen more often, and eat more vegetables and fruits. I also made an appointment with a genetic counselor to discuss my risk for cancer in more depth. After perusing the Internet, I felt more aware and able to take action to reduce my cancer risk.