Women with germline
BRCA1
or
BRCA2
(
BRCA1
/
2
) mutations are considered as an extreme risk population for developing breast cancer. Prophylactic mastectomy provides a valid option to reduce such ...risk, impacting however, the quality of life. Medical prevention by aromatase inhibitor that has also recently shown to have preventive effect may thus be considered as an alternative. LIBER is an ongoing double-blind, randomized phase III trial to evaluate the efficacy of 5-year letrozole versus placebo to decrease breast cancer incidence in post-menopausal
BRCA1
/
2
mutation carriers (NCT00673335). We present data on the uptake of this trial. We compared characteristics of women in the LIBER trial (
n
= 113) to those of women enrolled in the prospective ongoing national GENEPSO cohort (
n
= 1,505). Uptake was evaluated through a survey sent to all active centres, with responses obtained from 17 to the 20 (85%) centres. According to the characteristics of the women enrolled in the GENEPSO cohort and the survey, approximately one-third of
BRCA1
/
2
mutation carriers were eligible for the trial. Five hundred and thirty-four women eligible from chart review have been informed by mail about the prevention trial and were invited to an oral information by participating centres. Forty-four percentage of them came to the dedicated medical visit. Uptake of drug prevention trial was 32% among women informed orally and 15% of all the eligible women. The main reasons of refusal were: potential side effects, probability to receive the placebo and lack of support from their physicians. Additionally, we noticed that prior prophylactic oophorectomy and previous unilateral breast cancer were more frequent in women enrolled in the LIBER trial than in the French cohort (93% vs. 60% and 50% vs. 39%, respectively). Based on an overall 15% uptake among all eligible subjects, greater and wider information of the trial should be offered to women with
BRCA1
/
2
mutation to improve recruitment. Women with previous unilateral breast cancer or prior prophylactic oophorectomy are more likely to enter a medical prevention trial.
Oncolor, the French regional cancer network of Lorraine, proposes clinical guidelines for the diagnosis, the treatment and the follow-up of cancers. In addition to paper documents, two computerized ...supports, a web site and the Kasimir software have been developed to make the use of these guidelines and their updating easier. This study aims at evaluating these three tools in breast and prostate cancer and to determine if computerized supports provide an additional help and an added value. From May to July 2001, 25 physicians of the Oncolor network have analysed, by consulting the guidelines on each of the 3 supports, 23 clinical cases of breast cancer and 22 cases of prostate cancer, i.e. in total 1,293 cases. We observe for breast cancer a response rate consistent with the guideline significantly higher with the Kasimir software compared to paper (87.1% versus 77.8%) or to Internet (87.1% versus 75.8%), an optimisation of the recourse to a specialised physician or a pluridisciplinary committee and globally a good satisfaction of the users. These results induce us to continue with the Kasimir experiment, to develop it for other cancers, especially those with a complex management and to evaluate its impact on medical practices.
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