Breast Cancer Risk Assessment Tool Seems Accurate for 19 Years

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There are several breast cancer risk assessment tools that doctors use to calculate a woman’s risk of breast cancer. One of the most well-known is the Gail model, which assesses breast cancer risk based on a series of personal health questions that women and their doctors answer together. The result is a Gail score, which estimates the risk of developing invasive breast cancer in the next 5 years.

The Tyrer-Cuzick tool assesses breast cancer risk based on a woman’s answers to a series of questions, including age at first period, height, weight, childbearing history, family history of breast cancer, menopausal status, and any use of hormone replacement therapy. The result is an estimate of the likelihood a woman will develop invasive breast cancer specifically within 10 years of her current age, as well as over the course of her lifetime.

A study has found that the Tyrer-Cuzick breast cancer risk assessment tool is accurate for at least 19 years.

The research was published online on Sept. 13, 2018, by the journal JAMA Oncology. Read “Long-term Accuracy of Breast Cancer Risk Assessment Combining Classic Risk Factors and Breast Density.”

Short-term risk assessment tools, such as the Gail model, help women and their doctors decide if additional screening beyond a yearly mammogram is needed. Longer-term risk assessment tools help women and their doctors make decisions about other preventive strategies, such as taking medicine to reduce breast cancer risk or having surgery to remove the healthy breasts, and possibly the ovaries.

Most of the research done on risk assessment models has looked at accuracy within 5 years of when the risk assessment was done. So, the researchers wanted to look at the accuracy of the Tyrer-Cuzick tool over a longer period of time.

How the accuracy of the Tyrer-Cuzick tool was assessed

To do the study, the researchers looked at the records of 132,139 women whose risk of breast cancer was estimated using the Tyrer-Cuzick tool, with and without breast density included in the risk calculation:

  • None of the women had been diagnosed with breast cancer before joining this study.
  • The women’s ages ranged from 40 to 73 years.
  • All the women had regular breast cancer screening.
  • 80.4% of the women were white.

Overall, the median follow-up time was 5.2 years. This means that half the women were followed for a longer time and half the women were followed for a shorter time.

For the 46,436 women who were younger than 60 when they joined the study, median follow-up time was 10.8 years.

Overall, 2,699 invasive breast cancers were diagnosed in the women during follow-up. This number was very close to the number predicted by the Tyrer-Cuzick tool.

The Tyrer-Cuzick tool classified 2,554 women as being at high risk for breast cancer; 147 of these women were subsequently diagnosed with invasive disease.

The Tyrer-Cuzick tool that included breast density classified 4,645 women as being at high risk for breast cancer; 273 invasive breast cancers were diagnosed in these women.

“We evaluated the accuracy of long-term breast cancer risk assessment in a U.S. screening cohort and found that breast cancer risk models based on classic risk factors and mammographic density remain accurate during a longer period than considered to date,” the researchers wrote. “The long-term calibration of breast cancer risk models has important clinical implications. Arguably the main role of breast cancer risk assessment to date has been to triage women for genetic counseling and thereby guide their eligibility for genetic testing, preventive therapy, and screening modalities in addition to mammography. Our results lend support to extending such triage to more general high-risk clinics based on risk to 19 years using a combined risk assessment, not just familial risk associated with BRCA1/2 mutations or other inherited genetic factors. Combining mammographic density with classic risk factors appears to be particularly important for this aim because the strategy almost doubled the number identified in a high-risk group. Genetic or high-risk clinics may only have a moderate effect on breast cancer in the general population because most breast cancers are attributable to nongenetic factors.”

Estimating your personal risk of breast cancer

If you don’t know your personal risk of breast cancer, it makes sense to talk to your doctor about scheduling time to talk about risk factors and use a tool to estimate your risk.

If you know that you have a higher-than-average risk of breast cancer, you and your doctor will develop a screening plan tailored to your unique situation. General recommended screening guidelines include:

  • a monthly breast self-exam
  • a yearly breast exam by your doctor
  • a digital mammogram every year starting at age 40

Your personal screening plan also may include:

  • breast MRI
  • breast ultrasound

Talk to your doctor about developing a specialized program for early detection that meets your individual needs and gives you peace of mind.

It also makes good sense to do all that you can to keep your risk of breast cancer as low as it can be. Some lifestyle choices you may want to consider are:

  • maintaining a healthy weight
  • exercising every day
  • limiting or avoiding alcohol
  • eating a healthy diet that’s low in processed foods, sugar, and trans fats
  • not smoking

To learn more about breast cancer risk and other options to keep your risk as low as it can be, visit the Breastcancer.org Lower Your Risk section.

To discuss your risk with others, join the Breastcancer.org Discussion Board forum High Risk for Breast Cancer.


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