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Comprehensive Breast Cancer Risk Assessment
Studies measuring risk associated with individual risk factors have determined that the impact of certain factors can be magnified by the presence of other risk factors. Several mathematical models have been developed to help capture these interactions and predict a woman’s risk of future breast cancer. Breast specialists use these models to quantify an individual woman’s risk and tailor a proactive management plan to help reduce her risk and provide optimal monitoring.
The Gail Model was first published in 19891 and, despite its limitations, is still probably the most widely used because of its relative simplicity. While the Gail Model is very good at predicting how many women out of any particular group will develop breast cancer, it isn’t as helpful for identifying which women in the group are most likely to develop the disease.2 The Gail Model also lacks a few important factors that were discovered after its publication. You can find a modified version of the Gail Model on the National Cancer Institute’s website at http://www.cancer.gov/bcrisktool/. Note the significant impact of a finding of atypical hyperplasia on calculated risk with the Gail Model. Women who have had a finding of atypia from a HALO Well Breast Test should indicate that they have had one biopsy with atypical hyperplasia when completing the Gail model.
The Claus Model was published in 1994 and measures risk of hereditary breast cancer.3 It may be helpful for women with a family history of breast cancer, but 8 out of 9 women who develop breast cancer don’t have a primary family history of the disease.4
Several models measure risk of having either of 2 genetic mutations, BRCA 1 and BRCA 2, which are highly associated with breast cancer development, but since most breast cancer is not hereditary, these models are helpful only for a small percentage of the population.5 The ABC form includes criteria to help women decide whether to be tested for genetic mutations.
The current favorite among breast specialists is the Tyrer-Cuzick model published in 2004.6 It is thought to be the most comprehensive, overcoming some of the limitations of the Gail Model. However, it is time consuming to complete and requires a level of medical knowledge to complete it correctly. The Tyrer-Cuzick model is available at http://www.ems-trials.org/riskevaluator/.
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References:
1 Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 1989;81:1879–86.
2 Hollingsworth, A. 2000. The Truth About Breast Cancer Risk Assessment. The National Writer’s Press. Aurora, Colorado. p. 2.
3 Claus EB, Risch N, Thompson WD. Autosomal dominant inheritance
of early-onset breast cancer. Implications for risk prediction. Cancer
1994;73:643–51.
4 Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58,209 with breast cancer and 101,986 women without the disease. Lancet 2001;358:1389-1399.
5 Young Survival Coalition http://www.facingourrisk.org/docs/brochure_hereditary_bc.pdf Accessed 5/5/10.
6 Tyrer J, Duffy SW, Cuzick J (2004) A breast cancer prediction model incorporating familial and personal risk factors. Stat Med 23:1111–1130