Breast cancer represents up to 25% of new cancers in Canadian women and is the second most common cause of cancer-related mortality2. The umbrella term “breast cancer” includes a group of conditions with a number of distinct tumour types, genetic markers, and cancer stages. Treatments and approaches can vary based on patient preferences, local reimbursement models, evolving protocols, and awareness and availability of palliative care services3. This heterogeneity makes creating an overarching “breast cancer app” quite the challenge. Nonetheless, apps in this genre have the potential to 1) offer education, from prevention and screening, through to diagnosis, treatment, symptom management and follow-up, 2) help track the patient’s illness journey, and 3) provide important social support.
Likely due to the high prevalence of breast cancer, as well as the significance of the diagnosis, a huge number of apps related to breast cancer have emerged over the last few years. Unfortunately, this high quantity is generally not mirrored by a high quality, and many apps on the market have out-of-date content — rendering them misleading or even unsafe — as they do not keep up with ever-evolving recommendations and guidelines4.
The strongest feature of the apps reviewed here is the access they provide to supportive social networks, most notably through the MyBCTeam app. Some physicians, however, may not feel comfortable recommending these types of apps given that the forums aren’t moderated or vetted by health professionals. In general, the educational features are often fairly superficial, which likely reflects the challenge of providing relevant resources given the many different manifestations grouped under “breast cancer”. However, the multilingual introductory videos provided by the Beyond the Shock app may be a helpful starting resource for certain patients. Lastly, the tracking features of these apps — to follow treatments, symptoms, side effects — are generally underdeveloped. Healthcare providers might consider recommending more generic “symptom trackers” to patients who are interested in using the apps in this way (e.g. to track chronic pain).
When recommending these apps, it’s important to be aware of the biases that arise when apps are developed or funded by biotech or pharmaceutical companies. In these cases, biases are most notable in the heavy slant towards recommending “definitive” treatments (often chemotherapy), with less attention paid to the often significant treatment side effects. Apart from the forums, most apps make little or no mention of symptom management, palliative care options, or end-of-life concerns. We look forward to seeing this app genre evolve with time, and hope that interested organizations and developers will continue to find ways to best serve patients facing this life-changing diagnosis.
The BECCA app, developed by the Breast Cancer Care charity in the UK, provides links, resources and information to support individuals completing treatment for breast cancer via a series of browsable “flashcards”. While many of the flashcards provide interesting links and suggestions, the flashcard content feels quite random and leaves notable gaps, leading one to look elsewhere for more information. While the app design is clean and welcoming, most of the links are to external web-based resources and sites, some of which seem to be marketing particular products or services, with any financial relationships undisclosed. Many of the connected resources, including links to nurse support to answer specific questions, are UK-specific and thus less helpful for those living in other countries.
The flashcard topics range from combating fatigue, to finding a support group, to make-up tips for those who have lost their hair. The user can opt to receive “five of the best” suggestions per day. This app does an admiral job connecting the user with in-person (non-virtual) resources, including community-based centres, peer “meet-ups”, or live phone interactions with nurses. While these are fantastic features that bridge the digital world with the analog world, these are almost entirely for UK-based residents.
The app description states that “all information is checked by a panel prior to inclusion in the app,” though there is no mention as to who is on this panel, or how the content was reviewed. Several of the flashcard links connect to particular products or services, which raises a concern about the potential commercialization of certain aspects of the app.
Very clean, up-to-date design. A simple onboarding process explains the basics of the app. Virtually all the content is delivered via links that open in a browser outside the app, creating a disjointed user experience. The content isn’t searchable, so finding resources for a specific question can be a bit of a task.
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The app was generally reliable but would often crash at inconsistent times. The app has been updated within the last year.
The app is free and available for iOS and Android. No other languages besides English are supported.
Beyond the Shock
Billed as the “first and foremost resource for women who have been diagnosed with breast cancer”, Beyond the Shock is a basic and easy-to-use education and support iOS app. It is put out by the not-for-profit National Breast Cancer Foundation in the U.S., which does not seem to have particular ties to any industry groups (such as pharmaceutical companies). The app’s strength lies in providing a multilingual video series to explain the initial diagnosis of breast cancer, and in providing access to the narratives of others with breast cancer. A discussion forum enables users to discuss particular concerns, ask for advice, or view previously asked questions, but the forum isn’t particularly active, and doesn’t appear to be monitored for medical accuracy. As with most apps in this category, the educational focus is on diagnosis and treatment, with a notable lack of discussion regarding side effects related to cancer treatments, or symptom palliation.
The app presents a good series of educational videos that explain some of the science behind a cancer diagnosis. They are nicely animated and use clear, basic language. A second video series highlights the experiences of several individuals with lived experience with breast cancer. There are opportunities to view and ask questions of one’s peers, though active discussion is sparse, which probably limits the likelihood that users will engage more than a few times with the app.
While the description claims that the app was developed “with the support of the finest medical experts, doctors, and researchers”, it is unclear who was involved and how the expertise was incorporated. Also, there is no apparent moderation or vetting of the content in the discussion forums, with a few “superusers” seeming to provide the bulk of the medical advice.
The app is very simple and straightforward to use, with its main page guiding the user to “Learn”, “Ask” and “Hear.” The app has a dated aesthetic, and many sections rely on webpages, many of which aren’t tailored for the iOS environment, or are reliant on long blocks of small text to communicate their messages.
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The app has been updated in the last year; much of the video content is several years old, however most of this content relates to basic explanations of cancer and cancer types and wouldn’t necessarily need regular updating. Creating an account and log-in to post and comment was a very buggy and inconsistent experience, both through the app and the related website.
The content is available in multiple languages (Spanish, French, Chinese, and Portuguese), but these simply load the desktop version of the accompanying website in the selected language, which significantly diminishes the in-app experience. Fortunately, videos are re-done in each language and subtitles are provided for patient narratives, which are shared by women of different ages and backgrounds. This app is free, but only available on iOS devices.
My Cancer Coach
My Cancer Coach, which includes the “My Breast Cancer Coach” stream within it, helps individuals understand the treatment options related to their specific diagnosis. By asking users to input disease-specific information from their breast cancer pathology report, the app then tailors a report that discusses types of treatments that may be most appropriate. There is a strong emphasis on curative modalities (chemotherapy, radiation, and surgeries), even when individuals indicate they have a Stage 4 diagnosis, with no mention of symptomatic treatment, palliative care or end-of-life therapies, which does patients a disservice. A major concern is that the app is built by a genetic diagnostics company, and the content often seems preoccupied with their proprietary testing and directs patients to affiliated websites without clearly declaring this sales slant.
Beyond the pathology-specific management plan, the app also offers simple ways to track upcoming appointments and make entries in a simple journal. A basic glossary is a nice addition to help define some of the basic terms related to a breast cancer diagnosis, but it feels overly clinical. A widget to keep track of questions for upcoming visits (and email them directly to one’s physician) is a good idea but might not be very practical.
The video series, discussing general principles around breast cancer, is narrated by Dr. Marisa Weiss, who is an oncologist and has lived experience with breast cancer. However, there isn’t any clear information on the source or reliability of the remainder of the content, despite this being one of the apps that includes the most specific and direct medical information. Further, there is strong concern for bias given the backing of this app, however no conflicts of interest are declared.
The app has a fresh appearance, and most features are easy to understand. The treatment information, however, involves long paragraphs of small-font text and is hard to digest. The other features — including the calendar and journaling elements — seem like afterthoughts and aren’t particularly well developed.
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The app does advise users to utilize the app’s information in conjunction with direction from a medical professional, but this advice is buried among paragraphs of information. Helpfully, the app has been updated within the past year.
The app is free and available for both iOS and Android, but only in English. Getting tailored information on one’s diagnosis requires entering information from one’s breast cancer pathology report, which is often hard for individuals to access or interpret.
MyBCTeam focuses on providing online support and a social network for individuals who have been diagnosed with breast cancer. This site is one of a number of diagnosis-specific websites and apps created by myhealthteams.com to provide forums for discussion and support related to specific conditions (other sites include “DiabetesTeam” and “MyParkinsonsTeam”). The forums provide an active place for patients to share status updates and create a “team” of supportive individuals to follow (or who might follow them) during their cancer journey, and it is heartening to see the support that individuals give to one another through this community. While this app has the greatest potential for users to develop an online support network with meaningful interactions, this app should be recommended with caution, as some content appears to be sponsored by third parties without clear disclosure.
The core of this app is the discussion forum, where users can build a profile and respond to questions like “Given what I know now, I would recommend other women…” and “My life has changed in this way…”. Simple searches help individuals find “patients lik
The forums do not appear to be moderated or vetted, so all content is provided by users. There is a small education section in the accompanying website that describes a select number of specific cancer treatments (mostly chemotherapy medications) that see
The app has a very pleasant interface, is intuitive and not overly cluttered, and should be easy to use for anyone familiar with common social media platforms. The combination of structured and unstructured ways of sharing updates creates unintimidating w
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There is a strong plain-language summary, which clearly explains how and when information is shared. The app uses profile information as a way to recruit individuals for clinical trials, but this is explicitly mentioned, and there is a clear opt-in proces
The app is available for both iOS and Android for free, but only in English. Most of the users (and the advice) is U.S.-centric, but there are several hundred Canadian users active in the discussion forums.
- Drewes, C., Kirkovits, T., Schiltz, D., Schinkoethe, T., Haidinger, R., Goldmann-Posch, U., Wuerstlein, R. (2016). EHealth Acceptance and New Media Preferences for Therapy Assistance Among Breast Cancer Patients. JMIR Cancer, 2(2). doi:10.2196/cancer.5711
- Canadian Cancer Society, Statistics Canada, Public Health Agency of Canada, and Public Health Agency of Canada (n.d.). Canadian Cancer Statistics 2016. Special topic: HPV-associated cancers (Canada, Government of Canada). Retrieved from http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2016-EN.pdf?la=en
- Maughan, K.L., Lutterbie, M.A. and P.S. Ham, P.S. Treatment of breast cancer. Am Fam Physician, 2010. 81(11): p. 1339-46.
- Ginossar, T., Shah, S. F., West, A. J., Bentley, J. M., Caburnay, C. A., Kreuter, M. W., Kinney, A. Y. (2017). Content, Usability, and Utilization of Plain Language in Breast Cancer Mobile Phone Apps: A Systematic Analysis. JMIR mHealth and uHealth, 5(3). doi:10.2196/mhealth.7073