In the really old days, they were called pictographs; later they were called emoticons. Now, though, they’re called emojis, a new word originating in Japan for those smiley-face, thumbs-up and I-heart-you icons all over electronic devices. Emojis now include airplanes, jack-o-lanterns, kittens and just about every other animal – or fruit or facial expression – that one can imagine.
So why not use them in medicine?
"In most physicians' offices, there's a computer there," said Dr. Ian Thompson, director of the Cancer Therapy & Research Center. He said the usual discussion if a man’s PSA reading is high is “biopsy.”
But the biopsy is not without risk, and the argument now is whether all those biopsies are even needed because only a fraction of prostate cancers cause problems.
"Some 70%-80% of us will have those in our prostates in our lifetime, and yet, maybe 2%, or one in 30, one in 40, will cause problems. And so if you detect one of the tumors that will never cause a problem, you've not helped the man," Thompson said.
So Thompson helped develop the risk calculator to broaden the doctor’s conversation with patients. The new calculator offers the emojis – ten rows of ten smiley faces and frowning faces – that represent the patient’s true risk of a cancer becoming dangerous.
Thompson illustrated the 2.0 calculator's ability to assess risk based on random information. He input data that included a 55-year-old man who had never had a biopsy and whose dad had prostate cancer. He goes to the doctor, who finds the man has a PSA of 0.3 and finds a bump on the prostate and recommends the patient go to a urologist for a biopsy.
"In this particular man -- I just picked these numbers at random, a 55-year-old Hispanic man -- his risk of aggressive cancer is 1%," Thompson said. "His risk of detection of low-grade cancer, what is likely to be an inconsequential cancer, is 9%. So nine times more likely that it's an inconsequential cancer that doesn't need to be diagnosed today -- and most of them don't need to be diagnosed at all. He only has a 1 in 100 chance of being helped by a biopsy."
"So we take exactly the same man and we make his PSA 7; so a higher PSA. That man's risk of an aggressive cancer is now 10%, so 10 times higher," Thompson said, inputting new random data. "He would get many more frowning faces."
"And if we make the man 70, a little older, with the same PSA of 7, you now have a 19% risk. So all of these factors help us understand a man's risk so we can help the man individualize his choices."
Doctors can use the calculator to help them have a more comprehensive discussion about options with their patients. Thompson said the enhanced system can clarify the patient’s risk picture, and it provides a more accurate prediction of the outcome with biopsy because the calculator incorporates a substantially larger amount of patient data than the original calculator.
