InheRET: Finding At-Risk People Before They Become Cancer Patients
U-M startup InheRET is making an impact on patients and care centers with its tool that more accurately identifies which people are at risk for developing inherited cancers than standard family histories. It arms patients and their clinicians with information that enables careful monitoring and earlier intervention.
The Inherited Risk Evaluation Tool (InheRET) applies an algorithm based on National Comprehensive Cancer Network (NCCN) guidelines and other recognized standards to a patient’s detailed family history to determine the likelihood that the patient inherited a gene that predisposes them to cancer. The latest NCCN guidelines also include recommendations for testing and those have been incorporated into the algorithm along with risk assessment. Clinicians are alerted to patients with a high likelihood so that they, alongside the patient and a genetic counselor, can decide the best course of action.
According to InheRET Founder and CEO David Keren, “One out of five people are at an increased risk [to develop cancer] by family history. That’s more than 60 million people in the U.S. And more than 90% of them don’t know that they’re at increased risk.” Keren began his career as a U-M faculty member in the Department of Pathology in 1978, served as Medical Director of Warde Medical Laboratory, a clinical laboratory testing company, from 1989-2011, and returned to the U-M faculty in 2012.
A unique aspect to InheRET’s platform is that its family histories are designed to maximize the information a patient can provide. Genetic predictions are optimal when the family history goes back three generations, but it’s difficult to collect and provide that information in the few minutes before or during a doctor’s appointment. InheRET’s histories can be done from anywhere, are self-paced and online, giving patients time to collect information about family members’ illnesses.
In InheRET’s current business model, care providers pay a monthly subscription to provide InheRET to an unlimited number of patients. Patients benefit by receiving appropriate care including genetic testing and diagnostic or intervention procedures, while clinicians and their medical center benefit through increased staff efficiency, and the ability to schedule more patients and prioritize those at higher risk.
Building the Platform
Keren and team spoke with clinicians throughout Michigan and found there was no thorough or systematized method of identifying patients that would benefit from genetic testing.
The problem is two-fold: patients that should get genetic testing don’t, preventing early intervention; and patients that aren’t at a high risk for inherited cancers do, uncovering genetic variants that aren’t linked to disease but none-the-less cause distress and sometimes unnecessary medical interventions. InheRET’s platform addresses both scenarios.
In a U-M pilot study, InheRET evaluated the effect its platform had on genetic counselors with backlogs of 400 hundred patients waiting for initial appointments, during which they would normally fill out family histories on paper to determine if there were in fact genetic predispositions of concern. Patients took 4 to 6 weeks to return their documentation and more than 30% never returned it and were never seen. With InheRET’s patient-friendly interface, detailed histories were returned in an average of 72 hours, with a 90% completion rate. “Their backlog was reduced to almost nothing” using InheRET, Keren said.
Another positive effect was that U-M’s genetic counselors could see 1-2 more patients a day because having a family history filled out and analyzed ahead of time via InheRET shortened pre-appointment preparation time and appointment lengths.
InheRET will soon pilot its latest version of the platform, InheRET 3.0, which has significant upgrades.
From the outset, Keren wanted the company’s product to be accessible for everyone. Based on early feedback, the team developed the user interface of the platform at a 4th grade reading level, an improvement from a 9th grade level in the first prototypes.
InheRET 3.0 alerts clinicians to the exact genetic tests a patient needs, cutting out delays in determining which test to order. Additionally, InheRET is working towards contracts with testing companies so that clinicians can visit InheRET’s website to see the list of companies providing the genetic test, select and order it, while providing the insurance company with the pre-authorization information needed to cover the cost of the test.
InheRET is also expanding its commercial strategy with the help of new hire Kelly Hall, VP of Business Development. Hall was most recently VP of Commercial Strategy at CancerIQ and VP of Business Development at InformedDNA.
InheRET’s milestones for its current round of fundraising include executing contracts with several different groups, expanding its platform to CNS disease and cardiovascular disease products, and expanding its sales team. Read the “InheRET Milestones” box for more detailed information.
U-M has a financial interest in inheRET through a licensing agreement.