Breast Cancer Risk Assessment Can Spotlight Cancer Probability

Breast Cancer Risk:- In light of actress Olivia Munn’s recent breast cancer and double mastectomy announcement, Lisa Madlensky, PhD, genetic counselor at UC San Diego Health, is available to discuss the breast cancer risk assessment tool that Munn credits for saving her life, as well as the Breast Cancer High-Risk Program at UC San Diego Health.

Munn’s doctor calculated her assessment score, which revealed an increased lifetime risk of breast cancer. That led to an MRI, ultrasound and biopsy that detected cancer in both breasts, despite a "normal" mammogram report.

Breast cancer risk assessment tools take into account a patient’s medical, family and reproductive history in order to calculate the likelihood that they will develop breast cancer in the next five years, or their overall lifetime risk.

According to Munn, her lifetime risk was calculated at 37%.

So what are these tests? How do they work and who should take them and when? We asked experts.

What is a breast cancer risk assessment?

“A breast cancer risk assessment tool is one way that healthcare providers can estimate whether a woman has an increased chance of developing breast cancer,” explains Beth Peshkin, professor of oncology and certified genetic counselor at the Georgetown Lombardi Comprehensive Care Center.

The tools assess genetic factors such as a person’s family history of cancer, as well as non-genetic factors like their age, how old they were when they got their first period, how old they were the first time they gave birth and whether they’ve had previous breast biopsies.

One commonly used assessment tool, the Gail model, is available to take for free on the National Cancer Institute website, and can be completed in under 5 minutes.

The Gail model then calculates a person’s five-year risk of developing breast cancer, as well as their lifetime risk, and compares them with the average risk for women of the same age and race or ethnicity.

While the Gail model is fast and easy, more detailed tools are helpful for a more accurate assessment, says Dr Robert Smith, a cancer epidemiologist and senior vice president of Early Cancer Detection Science for the American Cancer Society. He says the Gail model is useful for indicating if the “risk is high enough, and your family history suggests that we need to pull out some more powerful assessment tools”.

The National Cancer Institute (NCI) also recommends more detailed tools like the IBIS Breast Cancer Evaluation Tool (also known as the Tyrer-Cuzik Risk Assessment Calculator) or the Boadicea model, which can also be taken online. Both of these take into account factors like a person’s height and weight, and require a more extensive family history.

What does a breast cancer risk assessment score mean?

While a breast cancer risk assessment score can be helpful, experts emphasize that it’s just a first step.

“If a person has a higher-than-average risk on a screening tool, the next step is to talk to a healthcare provider to determine the next steps,” says Peshkin. These might include heightened breast cancer screening procedures, like a breast MRI, or chemoprevention – the use of certain drugs like Tamoxifen to reduce one’s cancer risk. In some cases, genetic testing might be recommended, but Peshkin recommends that patients talk to a genetic counselor to determine the potential benefits, limitations and risks of such testing.

Smith points out that there are certain risk factors that can better be assessed by a healthcare provider than by an online tool, like a person’s breast density.

“Significant breast density can be associated with a higher risk of not being able to detect breast cancer just because you can’t see it [on a mammogram],” he says, adding that for some women, higher breast density is also a marker of increased risk. Newswise/SP