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Tyrer Cuzick Breast Cancer Risk

What Is Residual Breast Density

Dr. Cuzick Discusses Women at High Risk of Developing Breast Cancer

A simple formula for residual density is:

Actual breast density Predicted breast density = Residual breast density

Lets break that apart:

1) Studies have been conducted to identify the typical density for a patient of a specific age and body mass index and of average risk for developing breast cancer.5, 6, 7, 8 This breast density is known as predicted density.

2) Taking the difference between the predicted density and a patients actual density whether visually assessed using the ACR BI-RADS®Atlas or Volpara®Density volumetric breast density percentage determines the residual breast density risk.

3) If the residual breast density is positive, then the risk contribution due to breast density increases. Conversely, if the residual breast density is negative then the risk contribution due to breast density decreases.

In risk models like Tyrer-Cuzick where residual breast density is used in the calculation, additional factors like age, height and weight9 which were used to determine the predicted density value must be included to ensure the accuracy of the model.

Omitting this information will result in a faulty or incorrect risk assessment.

In the example below a womans lifetime risk score is calculated using the TC8 model with and without BMI information.

Without BMI, breast density residual risk cannot be determined because both are required to calculate this risk.

5. Brentnall, A. & Cuzick, J. Risk models for breast cancer and their validation, 2019.

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Breast Cancer Surveillance Consortium Risk Calculator

The Breast Cancer Surveillance Consortium Risk Calculator was developed and validated in 1.1 million women undergoing mammography across the United States, of whom 18,000 were diagnosed with invasive breast cancer. The BCSC Risk Calculator has been externally validated in the Mayo Mammography Health Study. In 2015, the BCSC risk calculator was updated to include benign breast disease diagnoses and to estimate both 5-year and 10-year breast cancer risk.

Neoplastic And Benign Risk Factors

Neoplastic conditions that increase the risk of breast cancer include the following:

  • Previous breast cancer
  • Ductal carcinoma in situ
  • Lobular carcinoma in situ

Benign breast conditions that slightly increase the risk of breast cancer include the following :

  • Hyperplasia
  • Sclerosing adenosis
  • Microglandular adenosis

Interestingly, a personal history of cervical cancer is associated with a lower incidence of developing breast cancer.

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Pharmacologic Interventions For Breast Cancer Risk Reduction

Guidelines for pharmacologic intervention in women who are at increased risk for breast cancer, but do not have a personal history of breast cancer, have been issued by the American Society of Clinical Oncology and the U.S. Preventive Services Task Force . The guidelines differ in their classification of increased risk and in their inclusion of women with lobular carcinoma in situ .

The Efficiency Of The Tyrer

Guide to Best Practices for Clinical Tyrer

The Gail model is a risk assessment tool that measures the risk of developing breast cancer in the next five years. As such, the model is considered a short-term screening model. It determines if a woman should go for further testing beyond a mammogram.

However, long-term risk assessment tools are crucial because they help doctors and patients consider preventative strategies such as taking medication, breast removal surgery, or ovary removal. Most women that take yearly mammogram may often ask, How is the accuracy of the Tyrer-Cuzick model assessed?

The researchers analyzed the records of 132,139 women who were determined to be at risk using the Tyrer-Cuzick model. None of the women in the study had previously been diagnosed with breast cancer but had regular breast cancer screening. The age distribution was 43 years to 73 years. Overall, the participants had a median follow-up time of 5.2 years, but 10.8 years for women under 60 years.

Initially, the Tyrer-Cuzick model had predicted 2,554 women were at high risk of developing breast cancer. Overall, 2,699 women were diagnosed with invasive breast cancer. The Tyrer-Cuzick model also predicted the 4,654 women would develop breast cancer based on their breast density. Of these, 147 were diagnosed with invasive cancer.

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Can You Estimate Your Personal Risk For Breast Cancer

If you are unaware of your risk for breast cancer, its best to talk to your doctor. However, if you have undergone testing and determined that you are at intermediate or high risk, its crucial to schedule a regular screening.

Generally, it is recommended that you do the following:

  • -Self-examinations for breast lumps
  • -Mammograms, especially for women above the age of 40
  • -Screening MRIs and ultrasounds
  • -You should also maintain a healthy lifestyle by maintaining healthy weight, exercising, avoiding drugs and alcohol, and eating a healthy diet.

Epidemiology Of Breast Cancer

Breast cancer is the most common type of cancer diagnosed in women, comprising 30% of all womens cancer diagnoses in the United States. The American Cancer Society estimates that 281,550 new cases of breast cancer will be diagnosed in women in 2021 . After lung cancer, breast cancer is the second leading cause of cancer-related death in women, accounting for 15% of cancer-related deaths.

The incidence of breast cancer has consistently outpaced the incidence of all other cancers in women in the US. In 2014-2018, the incidence rate of female breast cancer in the US was 129.1 per 100,000 population. Of note, the incidence of invasive breast cancers decreased between 1999 and 2004, which coincides with and is possibly attributable to better adherence to recommended screening mammography for the general population of women, as well as decreasing use of menopausal hormone replacement therapy .

Worldwide, breast cancer is the leading cause of cancer death in women. Although the United States and Western Europe have a five-fold higher number of new cases of breast cancer compared with Africa and Asia, since 1990, the death rate of breast cancer has declined by 24% in the United States . This may be due to increased use of screening mammography and of adjuvant chemotherapy.

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What Is The Importance Of Breast Cancer Risk Assessment

Its very simple. Women should be educated about their individual risk level.

With the Tyrer-Cuzick assessment model, Capitol Imaging Services can identify those women that may be at high risk. The model helps to inform a womans decision-making about genetic counselling and testing.

A breast cancer risk assessment model may be helpful in identifying women who may benefit from risk-reducing medications. It may also identify women who carry a mutation in the BRCA1 or BRCA2 gene. The Tyrer-Cuzick model may also be useful in determining women who would be most appropriate for high-risk screening breast MRI.

This risk assessment will automatically populate, if available, on each screening mammogram report. This is not something you or your medical provider have to request from Capitol Imaging Services.

Automatically Identify Patients With High

High-Risk Breast Health – Sarah Cannon Cancer Institute

Our integrated Risk Assessment Module calculates risk for Gail, BRCAPRO, Tyrer-Cuzick, B-RST, and other models based on electronic history. For those who have it, there is no need to log into another system or website. MagView automatically calculates the risk assessment score and flags high-risk patients in a single system. Integrate the score into your radiologists reporting platform with no interruption to their workflow.

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American Cancer Society Screening Guidelines

The ACS considers a woman to be at average risk for breast cancer in the absence of all of the following :

  • A personal history of breast cancer
  • A strong family history of breast cancer
  • A genetic mutation known to increase risk of breast cancer
  • A history of chest radiation therapy before the age of 30

For average-risk women, the ACS screening recommendations are as follows:

  • Age 40-44 – Starting screening with annual mammography is an option.
  • Age 45-54 – Annual mammography is recommended.
  • Age 55 and older – Transition to biennial screening or have the opportunity to continue screening annually. Continue screening as long as the woman is in good health and has a life expectancy of at least 10 years.
  • Clinical breast exams are not recommended for breast cancer screening in average-risk women at any age.

While not recommending breast self-exams as part of a routine breast cancer screening schedule, the ACS does advise that, “Women should be familiar with how their breasts normally look and feel and should report any changes to a health care provider right away.”

For women at high risk, the ACS recommends breast cancer screening with breast MRI and a mammogram every year, typically starting at age 30 and continuing for as long as they are in good health. Factors imparting high risk include the following :

The ACS found insufficient evidence to recommend for or against MRI screening in women with the following risk factors :

Q9 I Am In The High Risk Category Is There Anything I Can Do To Reduce My Risk Of Being Diagnosed With Breast Cancer

You should speak with your doctor about your specific circumstances to determine if there is anything you can do to lower your risk. In some cases, your doctor may recommend lifestyle changes, and in higher risk cases, there are risk lowering drugs and interventional surgery options. It is important, however, that your doctor make the appropriate recommendations.

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Menstrual And Obstetric History

Factors that increase the number of menstrual cycles also increase the risk of breast cancer, probably due to increased endogenous estrogen exposure. Such factors include the following:

  • Menarche when younger than 13 years
  • Nulliparity
  • First full pregnancy when older than 30 years
  • Not breastfeeding
  • Menopause when older than 50 years

Conversely, late menarche, anovulation, and early menopause are protective, owing to their effect on lowering endogenous estrogen levels or shortening the duration of estrogenic exposure.

Other factors affecting the risk of breast cancer include the following:

  • Tobacco exposure
  • Diethylstilbestrol exposure in utero
  • Alcohol consumption
  • Exposure to dichlorodiphenyldichloroethylene , a metabolite of the insecticide dichlorodiphenyltrichloroethane
  • Socioeconomic class
  • Hair product use

Additional File : Supplementary Materials

Tyrer

: Comparative validation of the BOADICEA and Tyrer- Cuzick breast cancer risk models incorporating classical risk factors and polygenic risk in a population-based prospective cohort of women of European ancestry.Additional details on the definition of study follow-up, sources of genotype data, risk factors in BOADICEA and Tyrer-Cuzick models, model validation methods are given. Supplementary Fig. 1. shows the study design in the validation cohort. Supplementary Fig. 2. shows a comparative validation of Tyrer-Cuzick model with and without PRS in the Generations Study. Supplementary Table 1 shows the risk factor distribution in the Generation Study. Figure . Calibration and discrimination of five-year risk predictions of breast cancer for women younger than 50years in the nested case-control sample of the Generations Study cohort with risk categories based on deciles of predicted five-year absolute risk. Figure . Calibration and discrimination of five-year risk predictions of breast cancer for women aged 50years or older in the nested case-control sample of the Generations Study cohort with risk categories based on deciles of predicted five-year absolute risk.

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Streamline Collection Of Patient Data

Patients can fill out required history information online from home or via tablet in your waiting room. The user-friendly format of our breast cancer risk assessment program makes it easy for patients to complete and eliminate manual entry for your staff. Yes, even for a complete Tyrer-Cuzick v8.0 assessment!

Q3 What Does It Mean To Have Dense Breast Tissue And Why Does It Matter For My Tyrer

Breast cancer research and advances in risk assessment have shown that having dense breasts is a contributing factor in determining a womans risk of breast cancer. Dense breast tissue refers to the appearance of breast tissue on a mammogram and the makeup of supportive and fatty tissue in the breast. The more fatty tissue, the less dense the breast is. Dense breast are common and can be caused by simply being younger, having a lower body mass index, or taking hormone therapy for menopause researchers are still studying why some women have dense breast and other do not. Non-dense tissue appears dark and transparent, whereas dense breast tissue appears as solid white area on a mammogram the solid white area can make it hard for radiologists to accurately analyze the image with a mammogram, so your provider may recommend supplemental imaging, like a breast ultrasound or other recommendations, to ensure no cancers are missed. Having dense breast alone is not cause for concern, and you should speak with your doctor about your breast density and how it affects your risk status.

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National Comprehensive Cancer Network

The NCCN guidelines recommend that SLNB should be performed and is the preferred method of axillary lymph node staging if the patient is an appropriate candidate for SLNB. Candidates include patients who are clinically node negative at the time of breast cancer diagnosis, with or without 12 suspicious nodes on imaging, and for whom no preoperative systemic therapy is planned.

If the sentinel lymph node is negative, no further axillary surgery is a category 1 recommendation. The NCCN recommends axillary dissection level I/II if the sentinel node is not identified or if the sentinel node is positive but the patient fails to meet all the following criteria:

  • T1 or T2 tumor
  • Only one or two positive sentinel lymph nodes
  • Breast-conserving surgery
  • Whole-breast radiation therapy planned
  • No preoperative chemotherapy

The NCCN recommends fine needle aspiration or core biopsy for patients whose breast cancer has any of the following characteristics:

  • Clinically node positive at time of diagnosis or
  • T2 or N1 and with preoperative systemic therapy planned or
  • T24,N13,M0

If FNA or core biopsy results are negative, the NCCN recommends SLNB. For those with positive results, the NCCN recommends axillary dissection I/II, although SLNB may be considered in selected cases .

The NCCN guidelines state that lymph node dissection is optional in the following cases:

Learn More About The Breakdown Of Each Percentage By Clicking On The Images Above Or By Scrolling Down And Looking At The Sections Below

Breast cancer prevention in high-risk post-menopausal women

If youve taken the Risk Assessment and have fallen into the Average Risk category, it is recommended that you continue your annual screening mammogram.

Non-Dense Breast Tissue

If youve taken the Risk Assessment and have fallen into the Intermediate Risk category, and your breast tissue is determined to be non-dense, it is recommended that you continue your annual screening mammogram.

Dense Breast Tissue

If youve taken the Risk Assessment and have fallen into the Intermediate Risk category, and your breast tissue is determined to be dense, it is recommended that you continue your annual screening mammogram, and include breast ultrasound as well.

If youve taken the Risk Assessment and have fallen into the High Risk category, it is recommended that you continue your annual screening mammogram, and include breast MRI as well.

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Use Of Biomarkers To Guide Adjuvant Systemic Therapy

A 2016 guideline from the American Society of Clinical Oncology advises that the only biomarkers that can guide choices of specific treatment regimens in breast cancer are as follows :

  • Estrogen receptor
  • Progesterone receptor
  • Human epidermal growth factor receptor 2

A 2022 update of the ASCO guideline regarding further biomarker use includes the following recommendations :

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Breast Cancer Risk Models That Include Breast Density

  • Tyrer-Cuzick is one of only two breast cancer risk assessment models that include breast density as a risk factor.
  • The other is the Breast Cancer Surveillance Consortium model. Dense Breast-Info provides a detailed list of whats included in bothwhich demonstrates the more-comprehensive nature of Tyrer-Cuzick, which includes:
  • Current age
  • Breast density
  • Ashkenazi descent
  • Age at diagnosis of first- and second-degree female relatives with breast or ovarian cancer and male relatives with breast cancer
  • What Are The Nccn Guidelines

    Variables used in the Gail, Claus, Ford, Tyrer

    The NCCN Guidelines are considered the standard of care in oncology. Reviewed annually by thousands of multidisciplinary clinicians and researchers, NCCN Guidelines are among the most thorough and up-to-date guidelines in medicine. Specifically, NCCN Guidelines include recommendations that identify high-risk patients who would benefit from genetic counseling and testing.When determining if a patient is eligible for genetic counseling, providers use “referral” guidelines. These are less stringent and more all encompassing than the guidelines used to determine a patients eligibility for genetic testing, which are known as the “testing” guidelines. The testing guidelines are more restrictive on, for example, age ranges and family history. At its core, these sets of guidelines provide a framework for individualized preventive care pathways.

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    American Society Of Clinical Oncology

    • For premenopausal with increased risk for breast cancer, offer tamoxifen to reduce the risk of invasive estrogen receptor positive breast cancer
    • In postmenopausal women, endocrine therapy options include anastrozole , exemestane , raloxifene , or tamoxifen .
    • Health care providers should discuss pharmacologic breast cancer risk reduction with women aged 35 years or older without a personal history of breast cancer who are at increased risk of developing invasive breast cancer.

    Tamoxifen

    ASCO guidelines recommend discussing use of tamoxifen, 20 mg per day orally for 5 years, as an option to reduce the risk of invasive breast cancer, specifically ER-positive breast cancer, in women 35 years of age or older who are premenopausal or postmenopausal and have a 5-year projected absolute breast cancer risk 1.66% or have LCIS. Risk reduction benefit continues for at least 10 years.

    ASCO guidelines advise that tamoxifen not be used in the following cases :

    • In women with a history of deep vein thrombosis, pulmonary embolus, stroke, or transient ischemic attack or during prolonged immobilization
    • In combination with hormone therapy
    • In women who are pregnant, may become pregnant, or are nursing mothers

    Raloxifene

    ASCO guidelines advise that raloxifene not be used in the following cases :

    • For breast cancer risk reduction in premenopausal women
    • In women with a history of deep vein thrombosis, pulmonary embolus, stroke, or transient ischemic attack or during prolonged immobilization

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