Providing access to risk prediction tools via the HL7 XML-formatted risk web service

Jonathan Chipman • Brian Drohan • Amanda Blackford • Giovanni Parmigiani • Kevin Hughes • Phil Bosinoff

Abstract Cancer risk prediction tools provide valuable information to clinicians but remain computationally challenging. Many clinics find that CaGene or HughesRiskApps fit their needs for easy- and ready-to-use software to obtain cancer risks; however, these resources may not fit all clinics’ needs. The HughesRiskApps Group and BayesMendel Lab therefore developed a web service, called ‘‘Risk Service’’, which may be integrated into any client software to quickly obtain standardized and up-to-date risk predictions for BayesMendel tools (BRCAPRO, MMRpro, PancPRO, and MelaPRO), the Tyrer-Cuzick IBIS Breast Cancer Risk Evaluation Tool, and the Colorectal Cancer Risk Assessment Tool. Software clients that can convert their local structured data into the HL7XML-formatted family and clinical patient history (Pedigree model) may integrate with the Risk Service. The Risk Service uses Apache Tomcat and Apache Axis2 technologies to provide an all Java web service. The software client sends HL7 XML information containing anonymized family and clinical history to a Dana-Farber Cancer Institute (DFCI) server, where it is parsed, interpreted, and processed by multiple risk tools. The Risk Service then formats the results into an HL7 style message and returns the risk predictions to the originating software client. Upon consent, users may allow DFCI to maintain the data for future research. The Risk Service implementation is exemplified through HughesRiskApps. The Risk Service broadens the availability of valuable, up-to-date cancer risk tools and allows clinics and researchers to integrate risk prediction tools into their own software interface designed for their needs. Each software package can collect risk data using its own interface, and display the results using its own interface, while using a central, up-to-date risk calculator. This allows users to choose from multiple interfaces while always getting the latest risk calculations. Consenting users contribute their data for future research, thus building a rich multicenter resource.

ChipmanHughes2013BCRTProvidingAccessToRiskPredictionToolsViaTheHL7XML-FormattedRiskWebService

Lumpectomy Plus Tamoxifen With or Without Irradiation in Women Age 70 Years or Older With Early Breast Cancer:  Long-Term Follow-Up of CALGB 9343

Kevin S. Hughes, Lauren A. Schnaper, Jennifer R. Bellon, Constance T. Cirrincione, Donald A. Berry,

Beryl McCormick, Hyman B. Muss, Barbara L. Smith, Clifford A. Hudis, Eric P. Winer, and William C. Wood

A B S T R A C T

Purpose

To determine whether there is a benefit to adjuvant radiation therapy after breast-conserving surgery and tamoxifen in women age _ 70 years with early-stage breast cancer.

Patients and Methods

Between July 1994 and February 1999, 636 women (age _70 years) who had clinical stage I (T1N0M0 according to TNM classification) estrogen receptor (ER) –positive breast carcinoma treated by lumpectomy were randomly assigned to receive tamoxifen plus radiation therapy (TamRT; 317 women) or tamoxifen alone (Tam; 319 women). Primary end points were time to local or regional recurrence, frequency of mastectomy, breast cancer–specific survival, time to distant metastasis, and overall survival (OS).

Results

Median follow-up for treated patients is now 12.6 years. At 10 years, 98% of patients receiving TamRT (95% CI, 96% to 99%) compared with 90% of those receiving Tam (95% CI, 85% to 93%) were free from local and regional recurrences. There were no significant differences in time to mastectomy, time to distant metastasis, breast cancer–specific survival, or OS between the two groups. Ten-year OS was 67% (95% CI, 62% to 72%) and 66% (95% CI, 61% to 71%) in the TamRT and Tam groups, respectively.

Conclusion

With long-term follow-up, the previously observed small improvement in locoregional recurrence with the addition of radiation therapy remains. However, this does not translate into an advantage in OS, distant disease-free survival, or breast preservation. Depending on the value placed on local recurrence, Tam remains a reasonable option for women age _ 70 years with ER-positive early-stage breast cancer.

J Clin Oncol 31:2382-2387. © 2013 by American Society of Clinical Oncology

HughesSchnaper2013_9343_JCO.2012.45.2615.full

Genetic breast cancer, hereditary breast cancer

Ozanne EM, Loberg A, Hughes S, Lawrence C, Drohan B, Semine A, Jellinek M, Cronin C, Milham F, Dowd D, Block C, Lockhart D, Sharko J, Grinstein G, Hughes KS. Identification and management of women at high risk for hereditary breast/ovarian cancer syndrome. The Breast Journal 2009 Mar; 15(2).

Schwartz GF, Hughes KS, Lynch HT, Fabian CJ, Fentiman IS, Robson ME, Domchek SM, Hartmann LC, Holland R, Winchester DJ, and the Consensus Conference Committee. Proceedings of the International Consensus Conference on Breast Cancer Risk, Genetics, & Risk Management, April, 2007. Breast J. 2009 Jan-Feb; 15(1): 4-16.

Prenatal

Lin BK, Edelman E, McInerney J, O’Leary J, Edelson V, Hughes KS, Drohan B, Kyler P, Puryear M, Scott JA, Dolan SM. Personalizing prenatal care using family health history: Identifying and integrating a panel of conditions into a novel screening tool. Per Med. 2013 10(3):307-318.

Edelman EA, Lin BK, Doksum T, Drohan B, Edelson V, Dolan SM, Hughes KS, O’Leary J, Vasquez L, Copeland S, Galvin S, DeGroat N, Pardanani S, Feero WG, Adams C, Scott JA. Evaluation of a novel electronic genetic screening and clinical decision support tool in prenatal clinical settings. Matern Child Health J, Oct 8 (Epub ahead of print).

Models

Biswas S, Atienza P, Chipman J, Hughes KS, Barrera AM, Amos CI, Arun B, Parmigiani G. Simplifying clinical use of the genetic risk prediction model BRCAPRO. Breast Cancer Res Treat. 2013 Jun;139(2):571-9. doi: 10.1007/s10549-013-2564-4. Epub 2013 May 21.

Chipman J, Drohan B, Blackford A, Parmigiani G, Hughes KS, Bosinoff P. Providing Access to Risk Prediction Tools via the HL7 XML-Formatted Risk Web Service. Breast Cancer Research and Treatment. (In Press)

Cowden’s syndrome 

Marsh DJ, Caron S, Dahia PLM, Kum JB, Frayling IM, Tomlinson IPM, Hughes KS, Eeles RA, Hodgson SV, Murday VA, Houlston R, Eng C.:  Germline PTEN Mutations in Cowden Syndrome-like Families.  J Med Genet 1998;35(11):881-5.

BRCA1 and BRCA2 

Hughes KS, Roche CA:  How Do We Apply Genetic Testing for Breast Cancer Susceptibility to Clinical Practice?  Journal of Surgical Oncology 1996;62:155-157.

Hughes KS, Roche CA, Whitney T, McLellan R.  The Management of Women at High Risk of Experiencing Hereditary Breast and Ovarian Cancer: The Lahey Guidelines.  Dis Manage Health Outcomes, 2000;7(4): 201-215.

Euhus DM, Smith KC, Robinson L, Stuky A, Olopade OI, Cummings S, Garber JE, Chittenden A, Mills GB, Rieger P, Esserman L, Crawford B, Hughes KS, Roche CA, Ganz PA, Joyce Seldon, Fabian CJ, Klemp J, Tomlinson G: Pre-test prediction of BRCA1 or BRCA2 mutation by risk counselors and the computer model BRCAPRO.  JNCI 2002;94:844-851

Berry DA, Iversen ES, Gudbjartsson DF, Hiller EH, Garber JE, Peshkin BN,  Lerman C,Watson P,Lynch HT,Hilsenbeck SG, Rubinstein WS, Hughes KS, Parmigiani G:  BRCAPRO Validation, sensitivity of genetic testing of BRCA1/BRCA2, and prevalence of other breast cancer susceptibility genes.  JCO 2002;20:2701-2712.

Hughes, KS, Ravnikar, V.  Risk Assessment and Management of Women with BRCA Mutations.  In: A Supplement to The Female Patient. 2009, Nov.

Guidelines

Murphy CD, Lee JM, Drohan B, Euhus DM, Kopans DB, Rafferty EA, Specht MA, Smith BL, Hughes KS. The American Cancer Society Guidelines for Breast Screening with Magnetic Resonance Imaging: An Argument for Genetic Testing. Cancer, 2008 Dec 1;113(11):3116-20.

Ozanne EM, Drohan B, Bosinoff P, Semine A, Jellinek M, Cronin C, Millham F, Dowd D, Rourke T, Block C, Hughes KS. Which Risk Model to Use? Clinical Implications of the ACS MRI Screening Guidelines. Cancer Epidemiol Biomarkers Prev. 2013 Jan;22(1):146-9. doi: 10.1158/1055-9965.EPI-12-0570. Epub 2012 Oct 23.

Breast Cancer Risk

Mackarem G, Roche CA, Hughes KS:  The effectiveness of the gail model in estimating risk for development of breast cancer in women under 40 years of age. Breast Journal 2001;7:34-39.

Dominguez FJ, Lawrence C, Halpern EF, Drohan B, Grinstein G, Black DM, Smith BL, Gadd MA, Specht MC, Kopans DB, Moore RH, RocheCA, HughesKS:  Accuracy of Self-Reported Personal History of Cancer in an Outpatient Breast Center.  Journal of Genetic Counseling 2006 June;16(3):341-5.  Epub 2007 May 17.

Jones JL, Hughes KS, Howard-McNatt M, Kopans DB, Moore RH, Hughes KS, Lee NY, Roche CA, Siegel N, Gadd MA, Smith BL, Michaelson JS:  Evaluation of hereditary risk in a screening mammography population.  Clinical Breast Cancer 2005;6(1): 38-44.

Schwartz GF, Hughes KS, Lynch HT, Fabian CJ, Fentiman IS, Robson ME, Domchek SM, Hartmann LC, Holland R, Winchester DJ, and the Consensus Conference Committee. Proceedings of the International Consensus Conference on Breast Cancer Risk, Genetics, & Risk Management, April, 2007. Cancer 113 (10): 2627-2637, 2008.

Hughes KS,RocheCA:  The Complexity of Breast Cancer Risk Needs to be Embraced, Not Oversimplified.  Menopause – The Journal of The North American Menopause Society (In press)

Metcalfe KA, Mian N, Enmore M, Poll A, Llacuachaqui M, Nanda S, Sun P, Hughes KS, Narod SA. Long-Term Follow-Up of Jewish Women with a BRCA1 and BRCA2 Mutation Who Underwent Population Genetic Screening. Breast Cancer Research and Treatment. 2012 Jun;133(2):735-40. Epub 2012 Jan 13.

Identification of high risk individuals

Ozanne EM, Loberg A, Hughes S, Lawrence C, Drohan B, Semine A, Jellinek M, Cronin C, Milham F, Dowd D, Block C, Lockhart D, Sharko J, Grinstein G, Hughes KS. Identification and Management of Women at High Risk for Hereditary Breast/Ovarian Cancer Syndrome. Breast Journal. 2009 Mar-Apr;15(2):155-62.

Samphao S, Wheeler AJ, Rafferty E, Michaelson JS, Specht MC, Gadd MA, Hughes KS, Smith BL. Diagnosis of Breast Cancer in Women Age 40 and Younger: Delays in Diagnosis Result From Underuse of Genetic Testing and Breast Imaging.  Am J Surg. 2009, Oct;198(4):538-43.

Buckley JM, Coopey SB, Sharko J, Polubriaginof F, Drohan B, Belli AK, Kim EM, Garber JE, Smith BL, Gadd MA, Specht MC, Roche CA, Gudewicz TM, Hughes KS. The Feasibility of Using Natural Language Processing to Extract Clinical Information from Breast Pathology Reports. J Pathol Inform. 2012;3:23. doi: 10.4103/2153-3539.97788. Epub 2012 Jun 30.

Drohan B, RocheCA, Cusack JC Jr., Hughes KS: Hereditary Breast and Ovarian Cancer and Other Hereditary Syndromes: Using Technology to Identify Carriers. Annals of Surgical Oncology. 2012 Jun;19(6):1732-7. Epub 2012 Mar 17.

Cusack JC Jr., Hughes KS. Managing Patients at High Risk for Hereditary Breast Cancer: A Guide for the Practicing Physician. Annals of Surgical Oncology. 2012 Jun;19(6):1721-2. doi: 10.1245/s10434-012-2255-0. No abstract available.

Prophylactic mastectomy

Black D, Specht M, Lee JM, Dominguez F, Gadd M, Hughes KS, Rafferty E, Smith B:  Detecting Occult Malignancy in Prophylactic Mastectomy: Preoperative MRI Versus Sentinel Lymph Node Biopsy.  Annual Surgical Oncology 2007;14(9):2477-84.  Epub 2007 Jun 22.

Hughes KS, Papa MZ, Whitney T, McLellan R: Prophylactic Surgery and Inherited Cancer Predisposition. In: Shaw G, Ed. Cancer Genetics for the Clinician, Plenum Publishers. 1999. p103-134.

Mackarem G, RocheCA, Silverman ML, Hughes KS: The Development of New, Primary, Noninvasive Carcinoma of the Breast 29 Years After Bilateral Radical Mastectomy. The Breast Journal 1998;4(1): 51-54

Breast Cancer After Hodgkin’s Lymphonma

Alm El-Din MA, Hughes KS, Raad RA, Goldberg SI, Aisenberg AC, Niemierko A, Taghian AG.  Clinical Outcome of Breast Cancer Occurring After Treatment for Hodgkin’s Lymphoma: Case-Control Analysis.  Radiation Oncology 2009 Jun 30;4:19.

M. Alm El-Din M, Hughes KS, Finkelstein D, Betts K, Yock T, Tarbell N, Aisenberg A and Taghian AG. Breast Cancer After Treatment of Hodgkin’s lymphoma: Risk Factors That Really Matter. Int J Radiat Oncol Biol Phys. 2009 Jan 1;73(1):69-74. Epub 2008 Jun 4.

Breast Density

Del Carmen MG, Halpern EF, Kopans DB, Moy B,
Moore RH, Goss P, Hughes KS: Mammographic Breast Density and Race.  American Journal of Roentgenology
2007;188(4):1147-50.

Disparities, Racial Issues in Breast Cancer

del Carmen MG , Hughes KS, Halpern E, Rafferty E, Kopans D, Parisky YR, Sardi A, Esserman L, Rust S, and Michaelson J:  Racial differences in mammographic breast density.  Cancer 2003;98(3): 590-596

Breast Cancer In Older Women

Hughes KS, Schnaper L, Berry D, Cirrincione C, McCormick B, Smith T, Shank B, Smith BL, Shapiro C, Muss H, Winer E, Wood W, Sugarbaker D, Henderson C, Norton L: A randomized comparison of lumpectomy plus Tamoxifen with or without irradiation in women 70 years of age or older with early stage breast cancer.  New England Journal of Medicine 2004;351: 971-977.

Hughes KS. Why Do We Believe That Breast Cancer in the Elderly is the Same as Breast Cancer in Young Women? Drugs Aging. 2008;25(1):47-8.

Inouye P, Schnaper, LA, Buyske J, Shank BM, Shapiro CL, Berry DA, Wilder KLM, Hughes KS: Carcinoma of the Breast in the Geriatric Population. Surgical Rounds 1997;4 (3): 146-20.

Schnaper LA, Hughes KS: Special Considerations When Treating Breast Cancer in the Elderly.  Breast Disease – An International Journal 2001;12: 83-93.

Schnaper LA, M.D.Hughes KS, M.D., for the Cancer and Leukemia Group B, Radiation Therapy, Oncology Group, and Eastern Cooperative Oncology Group: Can Radiation be Omitted Following Breast Conserving Surgery in Women Over 70 With Early Stage Breast Cancer? The American Journal of Oncology Review. In Press.  2004

Howard-McNatt M, Hughes KS, Schnaper LA, Jones JL, Gadd MA, Smith BL: Breast Cancer Treatment in Older Women. Surgical Clin NA, 2005;14(1): 85-102, vi. Review.

Hughes KS. Why Do We Believe That Breast Cancer in the Elderly is the Same as Breast Cancer in Young Women? Drugs and Aging 2008;25:47-48.

Carlson RW, Moench S, Hurria A, Balducci L, Burstein HJ, Goldstein LJ, Gradishar WJ, Hughes KS, Jahanzeb M, Lichtman SM, Marks LB, McClure JS, McCormick B, Nabell LM, Pierce LJ, Smith ML, Topham NS, Traina TA, Ward JH, Winer EP.  NCCN Task Force Report: breast cancer in the older woman.  The Journal of the National Comprehensive Cancer Network. 2008;6 Suppl 4:S1-S25.  Quiz S26-S27.

Kimmick G, Hughes KS, Muss H: Breast Cancer in Older Women.  In: Harris J, Lippman M, Morrow M, Osborne C (eds.) Diseases of the Breast, Lippincott Williams and Wilkins. 2004 and 2009

Breast conservation

Schwartz GF, Veronesi U, Clough KB, Dixon JM, Fentiman IS, Heywang-Kobrunner SH, Holland R, Hughes KS, Mansel RE, Margolese R, Mendelson EB, Olivotto IA, Palazzo JP, Solin LJ: Consensus Conference Committee.  Proceedings of the consensus conference on breast conservation, Milan, Italy, April 28-May 1, 2005: Simultaneously published in:  Int Journal Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1281-8. J Am Coll Surg. 2006 Aug;203(2):198-207.  Breast J. 2006 Jul-Aug;12(4):398-407.  Cancer. 2006 Jul 15;107(2):242-50.

K.R. Kozak, B. L. Smith, J. Adams, E. Kornmehl, A. Katz, M. Gadd, M. Specht, Hughes KS,V Gioioso, H-M Lu, K. Braaten, A. Recht, S. N. Powell, T. F. DeLaney and A. G. Taghian. Accelerated Partial Breast Irradiation Using Proton Beams: Initial Clinical Experience Int J Radiat Oncol Biol Phys, 2006 Nov 1;66 (3):691-86.

Schwartz GF, Veronesi U, Clough KB, Dixon JM, Fentiman IS, Heywang-Kobrunner SH, Holland R, Hughes KS, Mansel RE, Margolese R, Mendelson EB Olivotto IA, Palazzo JP, Solin LJ; Consensus Conference Committee: Proceedings of the consensus conference on breast conservation.  Simultaneous Publications:  International Journal of Radiation Oncology Biol Phys. 1;65(5):1281-8.  J American College of Surgery. 203(2):198-207. Breast J. 12(4):398-407.  Cancer 2006:107(2):242-50.

Kirstein LJ, Taghian A, Hughes KS.  Management and Outcomes of Ipsilateral Recurrence Following Breast Conservation.  Seminars in Breast Disease 2007 (Vol 10:4) p. 169-177.

Schnaper LA, Hughes KS:  The use of radiation in the elderly. Breast Cancer Online 2007;10(1): 1-3.

Management of lymph nodes, axillary dissection, sentinel node biopsy

Mackarem G, Barbarisi L,HughesKS:  The role of axillary dissection in early stage breast cancer.  Cancer Investigations 1992;10(5):461-470.

HughesKS:  Technique for axillary dissection:  Use of the Bookwalter retractor.  Contemporary Surgery 1993; 42(3):189-193

Dominguez F, Golshan M, Black D, Hughes KS, Gadd M, Christian R, Lesnikoski B, Specht M, Michaelson J, Smith B.  Sentinel node biopsy is important in mastectomy for ductal carcinoma in situ.  Ann Surg Oncol. 2008 Jan;15(1):268-73. Epub 2007 Sep 22.

Benign disease, abnormal mammogram, breast mass, breast lump

Argy O,HughesKS,RocheCA: Management of the Patient With a BreastMass.  In: Manual of Breast Diseases, Lippincott. 2001

Buyske J,HughesKS, Tronic BS:  Adenoma of the nipple.  Surgical Rounds 1995;18(8): 323-24.

Katz M, Schapira L, Harisinghani M,HughesKS: Palpable right breast mass in a pregnant woman. Nature Clinical Practice Oncology 2005 Apr;2(4):218-221; quiz 1 p following 222.

Shi AA, Georgian-Smith D, Cornell LD, Rafferty EA, Staffa M,HughesKS, Kopans DB: Radiological reasoning: male breast mass with calcifications.  American Journal of Research 2005;185: S205-213.

Hormones

Hughes KS, Roche CA.  HRT Revisited: Data from the population, treatment for the patient.   Menopause 2003;10(4):269-70.

Surgical Technique

Dominguez FJ, KawaguchiAL, O’Malley C, Hughes KS:  Elastic stay hooks and bookwalter retractor technique for raising mastectomy skin flaps.  Surgery 2007;141(2):272-4.

Hughes, KS. Smith, BL, Wheeler, A. The Cancer and Leukemia Group B Trials. In: Breast Surgical Oncology.New York,New   York: McGraw Hill; 2010. [in press]

Non-invasive Breast Cancer (DCIS, Ductal Carcinoma in situ) 

Hughes KS, Lee AKC, McLellan R, Mackarem G, Camus M, Joshi M, Walsh JM, Heatley GJ, Rossi RL, Munson JL, Braasch JW, Tsao J, Sanders LE, Barbarisi LJ, Lo TCM, Girshovich L, Healey GA, Buyske J:  Breast-conserving therapy for patients with ductal carcinoma in situ.  Breast Diseases 1996;9:255-268.  

Pandya S, Mackarem G, Lee AKC, McLellan R, Heatley GJ, Hughes KS:  Ductal carcinoma-in-situ:  the impact of screening on clinical presentation and pathologic features.  The Breast Journal  1998;4(3): 146-151

Hughes KS, Lee AK, Rolfs A:  Controversies in the treatment of ductal carcinoma in situ.  Surgical Clinics of North America 1996;76(2): 243 – 265. 

Murphy C, Jones J, Javid S, Michaelson M, Noaln M, Lipsitz S, Specht M, Lesnikoski B, Hughes KS, Gadd M, Smith S: Do Sentinel Node Micrometastases Predict Local Recurrence Risk in Ductal Carcinoma in Situ (DCIS) and Ductal Carcinoma in Situ with Microinvasion (DCISM)?  American Journal of Surgery.  2008 (Epub ahead of print)

Early Breast Cancer

Lee KC, Loda M, Bosari S, Mackarem G, DeLellis RA, Heatley GJ, Hughes KS:  Node-negative invasive breast carcinoma 1cm or less in size (T1a,bNoMo) –Clinicopathologic features and outcome.  Cancer 1996;79 (4): 761-771.

Michaelson JS, Silverstein M, Wyatt J, Weber G, Moore R, Kopans DB, Hughes KS: Predicting the survival of patients with breast carcinoma using tumor size. Cancer 2002;95:713-23.

Male Breast Cancer

Camus M, Joshi M, Mackarem G, Lee A, Rossi R, Munson JL, Buyske J, Barbarisi L, Sanders L, Hughes KS:  Ductal carcinoma in situ of the male breast.  Cancer 1994;74:1289-1293.

Joshi MG, Lee AKC, Loda M, Camus MG, Pedersen C, Heatley GJ, Hughes KS:  Male breast carcinoma:  An evaluation of prognostic factors contributing to a poorer outcome.  Cancer 1996;77:490-98.

Family History

Hughes KS, Roche CA, Campbell CT, Siegel N, Salisbury L, Chekos A, Katz MS, Edell E: Prevalence of family history of breast and ovarian cancer in a single primary care practice using a self-administered questionnaire. The Breast Journal 2003;9: 19-25

Dominguez FJ, Jones JL, Zabicki K, Smith BL, Gadd MA, Specht MC, Kopans DB, Moore RH, Michaelson JS, Hughes KS:  Prevalence of hereditary breast/ovarian cancer risk in patients with a personal history of breast or ovarian cancer in a mammography population.  Cancer 2005;104: 1849-53.

Shabo A, Hughes KS:  Family history information exchange services using HL7 clinical genomics standard specifications.  Int’l Journal on Semantic Web and Information Systems. 2005;1(4): 42-65

Ozanne EM, O’Connell A, Bouzan C, Bosinoff P, Rourke T, Dowd D, Drohan B, Millham F, Griffin P, Halpern E, Semine A, Hughes K. Bias in the reporting of family history: Implications for clinical care. Journal of Genetic Counseling. 2012 Jan 12. [Epub ahead of print]

Drohan B, Roche C, Hughes KS: Hereditary Breast and Ovarian Cancer and Other Hereditary Syndromes: Using Technology to Identify Carriers. Annals of Surgical Oncology (In press)

Dominguez FJ, Lawrence C, Halpern EF, Drohan B, Grinstein G, Black DM, Smith BL, Gadd MA, Specht MC, Kopans DB, Moore RH, Hughes KS, Roche CA, Hughes KS:  Accuracy of self-reported personal history of cancer in an outpatient breast center.  Journal of Genetic Counseling 2007 June;16(3):341-5.  Epub 2007 May 17.

Karen H Lu, Marie E Wood, Molly Daniels, Cathy Burke, James Ford, Noah D Kauff, Wendy Kohlmann, Noralane M Lindor, Therese Marie Mulvey, Linda Robinson, Wendy S Rubinstein, Elena M. Stoffel, Carrie Snyder, Sapna Syngal, Janette K Merrill, Dana S Wollins, and Kevin S. Hughes. ASCO Expert Statement: Collection & Utilization of a Cancer Family History for Oncology Providers. Journal of Clinical Oncology. 2013.

Marie E Wood, Pamela Kadlubek, Trang Pham, Dana S Wollins, Karen H Lu, Jeffrey N Weitzel, Michael N Neuss, and Kevin S. Hughes. Quality of Cancer Family History and Referral for Genetic Counseling and Testing Among Oncology Practices. A pilot testing of quality measures as part of the ASCO Quality Oncology Practice Initiative (QOPI®). Journal of Clinical Oncology. 2013.

High Risk Lesions, Atypical Ductal Hyperplasia (ADH), Atypical Lobular Hyperplasia (ALH), Lobular Carcinoma in situ (LCIS), Severe ADH, Borderline DCIS

Mackarem G, Yacoub LK, Lee AKS, Barbarisi LJ, Cuttino J, Hughes KS:  Effects of screening on detection of lobular carcinoma in situ of the breast:  Non-specificity of mammography and physical examination.  Breast Diseases  1994;7:339-345

Pandalai PK, Mariciani V, Lerwill MF, RocheCA, Hughes KS.   The Medical and Surgical Management of Atypical Hyperplasia and LCIS.  In:  Multidisciplinary Approach to Breast Cancer.  Eds: Taghian A, Smith BL, Erban J.  Demos Medical Publishing,New York. 2009.

Coopey SB, Mazzola E, Buckley JM, Sharko J, Belli AK, Kim EM, Polubriaginof F, Parmigiani G, Garber JE, Smith BL, Gadd MA, Specht MC, Guidi AJ, Roche CA, Hughes KS. The Role of Chemoprevention in Modifying the Risk of Breast Cancer in Women with Atypical Breast Lesions. Breast Cancer Research and Treatment. 2012 Dec;136(3):627-33. doi: 10.1007/s10549-012-2318-8. Epub 2012 Nov 2.

Biomarkers for breast cancer

Joshi MG, Lee AKC, Pedersen CA, Schnitt S, Camus MG, Hughes KS: The role of immunocytochemical markers in the differential diagnosis of proliferative and neoplastic lesions of the breast.  Modern Pathology 1996;9(1): 57-62.

Rieger-Christ KM, Pezza JA, Dugan JM, Braasch JW, Hughes KS, Summerhayes IC:  Disparate E-cadherin mutations in LCIS and associated invasive breast carcinomas.  Molecular Pathology 2001;54(2):91-7.

Screening for breast cancer, mammography, screening mammograms

Pandya S, Mackarem G, Lee AKC, McLellan R, Heatley GJ, Hughes KS:  Ductal carcinoma-in-situ:  the impact of screening on clinical presentation and pathologic features.  The Breast Journal  1998;4(3): 146-151

Parisky YR, Sardi A, Hamm R, Hughes KS, Esserman L, Rust S, Callahan K: Efficacy of computerized infrared imaging analysis in the discrimination of mammographically suspicious lesions.  American J of Roentgenology 2002;180: 263–269.

Kopans DB, Rafferty E, Georgian-Smith D, Yeh E, D’Alessandro H, Moore R, Hughes KS, Halpern E:  A simple model of breast cancer growth may provide explanations for observations of apparently complex phenomena.  Cancer 2003;97(12): 2951-2959

Del Carmen MG, Halpern EF, Kopans DB, Moy B, Moore RH, Goss P, Hughes KS: Mammographic breast density and race.  American Journal of Roentgenology 2007;188(4):1147-50.

Michaelson J, Satija S, Moore R, Weber G, Halpern E,Garland A, Kopans D, Hughes KS: Estimates of the sizes at which breast cancers become detectable on mammographic and on clinical grounds.  J Women’s Imaging 2003;5:10-19

Blanchard K, Weissman J, MoyB, PuriD, Kopans D, Kaine E, MooreR, Halpern E, Hughes KS, Tanabe K, Smith B, Michaelson J:  Mammographic screening: patterns of use and estimated impact on breast carcinoma survival.  Cancer 2004;101:3: 495-507.

Michaelson JS, Satija S, Kopans DB, Moore RA, Silverstein, M, Comegno A, Hughes KS, Taghian A, Powell S, Smith, B:  Gauging the impact of breast cancer screening, in terms of tumor size and death rate.  Cancer 2003:98(10):2114-2124