Assessment for Risks of Breast Cancer

Breast Cancer Awareness

Written by : Dr.M.D.Mazumdar, MD

Breast cancer awareness can help a woman assess if they are at risk for invasive breast cancer.

The Breast Cancer Risk Assessment Tool (BCRAT) is based on a statistical model known as the Gail Model, named after Dr. Mitchell Gail, Senior Investigator in the Biostatistics Branch of the NCI Division of Cancer Epidemiology and Genetics The tool is meant for health personnel to help assess a women's risk of getting invasive breast cancer over a 5-year period of time and up to age 90 (lifetime risk). It also compares the woman's risk with the average risk for a woman of the same age.

As per the National Cancer Institute, the tool uses a woman's personal, medical and reproductive history and the history of breast cancer among her first-degree relatives (mother, sisters, daughters) to estimate absolute breast cancer risk - her chance or probability of developing invasive breast cancer in a defined age interval.

A number of risk factors are taken into account. These are:

  • Personal history - of breast abnormalities like DCIS and LCIS.

  • Age - The risk of breast cancer increases in women older than 50 years.

  • Age at first menstrual period- The Age at first menstrual period is an important factor. Women who had their first menstrual period before the age of 12 years have a slightly increased risk of breast cancer.

  • Age at first live birth - Risk increases if the birth of the first child occured at an early age.

  • Family History - Having one or more first-degree blood relatives who have been diagnosed with breast cancer increases a woman's risks of developing breast cancer.

  • Breast biopsies - Women who have had breast biopsies due to a dense breast tissues which shows a condition known as atypical hyperplasia have an increased risk of breast cancer.

Drawbacks of the Breast Cancer Assessment Tool

  • Not all risk factors have been taken into account in this tool. These risk factors are age at menopause, use of birth control pills, use of HRT, high body mass index, a high-fat diet, alcohol, radiation exposure and environmental pollutants. There is no definite evidence that these factors contribute to breast cancer risks of women although it is very likely that they do do so.

  • The Breast Cancer Assessment Tool may underestimate the risks in African-American women. The overall incidence of breast cancer is less in these women, but they tend to get a more aggessive form of breast cancer when they do get them and there is more risk of them dying from the condition. But a new version of the model, called CARE, using data from African-American women has now been developed by NCI researchers.

  • The tool is only meant for women over the age of 35 years.

  • The tool cannot be used in women who have already had a diagnosis of breast cancer or in women exposed to breast radiation for treatment of Hodgkin lymphoma.

  • It is not applicable in women who have recently migrated from other countries like China or Japan where breast cancer risks are less. This is because the data collected for the tool is mainly from non-hispanic white American women.

  • It is not applicable in men.
The Breast Cancer Assessment Tool is quite accurate as long as the drawbacks are kept in mind.

Other risk assessment tools for breast cancer :

  • Tyrer-Cuzick model (IBIS tool): This tool is used to calculate a person's likelihood of carrying the BRCA1 or BRCA2 mutations. It estimates the likelihood of a woman developing breast cancer in 10 years and over the course of her lifetime.

  • Claus Model: It uses family history to estimate breast cancer risk. Such tools can be used for women who have one or more relatives with breast cancer or one or more relatives with ovarian cancer.
The breast cancer assessment tols should be used with caution adn under direction of a medical personnel.

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