How Are The Models Used
1. To identify women who may benefit from risk-reducing medications
The Gail model is used to determine risk for purposes of advising on use of medications to reduce risk. In the National Surgical Adjuvant Breast and Bowel Project P1 study, women at increased risk for breast cancer were defined as follows: 1) age 35 to 59 years with at least a 1.66% five-year risk for developing breast cancer by the Gail model; or 2) personal history of lobular carcinoma in situ ; or 3) age over 60 years. 13,388 such women were randomized to receive tamoxifen or placebo daily for five years. Tamoxifen reduced the risk of invasive breast cancer by 49% and reduced the risk of noninvasive cancer by 50%.
The reduced risk of breast cancer was only seen for estrogen-receptor expressing tumors. There was a 2.5-fold increase in risk of endometrial cancer in women taking tamoxifen and a decrease in hip and spine fracture risk. Blood clots causing stroke and deep vein thrombosis are increased in women taking tamoxifen .
2. To identify women who may carry a pathogenic mutation in;BRCA1;or;BRCA2
Some models will also calculate the probability of a;BRCA1/2;mutation; however, most testing guidelines are now criterion based as opposed to probability based. In practical terms, clinical decision-making around genetic testing is rarely based on a;priori;probabilities.
3. To identify women who meet criteria for high-risk screening MRI
References Cited
Expert Review And References
- American Institute for Cancer Research / World Cancer Research Fund. Continuous Update Project Report: Diet, Nutrition, Physical Activity and Breast Cancer. 2017: .
- Lester J. Early stage breast cancer. Yarbro CH, Wujcki D, Holmes Gobel B, . Cancer Nursing: Principles and Practice. 8th ed. Burlington, MA: Jones and Bartlett Learning; 2018: 47: 1279 – 1334.
- Morrow M, Burstein HJ, and Harris JR. Malignant tumors of the breast. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 79: 1117-1156.
- National Cancer Institute. Genetics of Breast and Gynecologic Cancers Health Professional Version. 2016: .
- National Cancer Institute. Breast Cancer Screening Health Professional Version. 2017: .
- National Cancer Institute. Breast Cancer Prevention Health Professional Version. 2017: .
- World Health Organization. Breast Cancer: Prevention and Control. Geneva: World Health Organization ; 2017.
Common Risks For Breast Cancer
According to the National Cancer Institute below are the factors that increase a womens risk of getting breast cancer:
The strongest risk factor;for breast cancer is age. A womans risk of developing this disease increases as she gets older. The risk of breast cancer, however, is not the same for all women in a given age group. Research has shown that women with the following risk factors have an increased chance of developing breast cancer.
Genetic alterations : Inherited changes in certain genes increase the risk of breast cancer. These changes are estimated to account for no more than about 10 percent of all breast cancers. However, women who carry changes in these genes have a much higher risk of breast cancer than women who do not carry these changes.
Family history: A womans chance of developing breast cancer increases if her mother, sister, and/or daughter have been diagnosed with the disease, especially if they were diagnosed before age 50. Having a close male blood relative with breast cancer also increases a womans risk of developing the disease.
Personal history;of breast cancer: Women who have had breast cancer are more likely to develop a second breast cancer.
Alcohol: Studies indicate that the more alcohol a woman drinks, the greater her risk of breast cancer.
Long-term use of;menopausal hormone therapy: Women who used combined estrogen and progestin menopausal hormone therapy for more than 5 years have an increased chance of developing breast cancer.
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Cancers Linked To Treatment With Tamoxifen
Taking tamoxifen lowers the chance of hormone receptor-positive breast cancer coming back. It also lowers the risk of a second breast cancer. Tamoxifen does, however, increase the risk for uterine cancer . Still, the overall risk of uterine cancer in most women taking tamoxifen is low, and studies have shown that the benefits of this drug in treating breast cancer are greater than the risk of a second cancer.
Medicines To Lower Breast Cancer Risk
Prescription medicines can be used to help lower breast cancer risk in certain women at increased risk of breast cancer.
Medicines such as tamoxifen and raloxifene block the action of estrogen in breast tissue. Tamoxifen might be an option even if you havent gone through menopause, while raloxifene is only used for women who have gone through menopause. Other drugs, called aromatase inhibitors, might also be an option for women past menopause. All of these medicines can also have side effects, so its important to understand the possible benefits and risks of taking one of them.
To learn more, see:
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What Is The Average American Womans Risk Of Being Diagnosed With Breast Cancer At Different Ages
Many women are more interested in the risk of being diagnosed with breast cancer at specific ages or over specific time periods than in the risk of being diagnosed at some point during their lifetime. Estimates by decade of life are also less affected by changes in incidence and mortality rates than longer-term estimates. The SEER report estimates the risk of developing breast cancer in 10-year age intervals . According to the current report, the risk that a woman will be diagnosed with breast cancer during the next 10 years, starting at the following ages, is as follows:;
- Age 30 . . . . . . ;0.49%
- Age 40 . . . . . . ;1.55%
- Age 50 . . . . . . ;2.40%
- Age 60 . . . . . . ;3.54%
- Age 70 . . . . . . ;4.09%
These risks are averages for the whole population. An individual womans breast cancer risk may be higher or lower depending on known factors, as well as on factors that are not yet fully understood. To calculate an individual womans estimated breast cancer risk, health professionals can use the Breast Cancer Risk Assessment Tool, which takes into account several known breast cancer risk factors.;
Previous Breast Cancer Or Lump
If you have previously had breast cancer or early non-invasive cancer cell changes in breast ducts, you have a higher risk of developing it again, either in your other breast or in the same breast.
A;benign breast lump does not mean;you have breast cancer, but certain types of breast lumps may slightly increase your risk of developing cancer.
Some benign changes in your breast tissue, such as;cells growing abnormally in ducts;, or;abnormal cells inside your breast lobes , can make getting breast cancer more likely.
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How To Interpret Your Estimated Breast Cancer Risk
The Breast Cancer Risk Assessment Tool was designed to be used by health care providers. So, if you use the tool on your own, it may be hard to understand the results and use the information to make decisions about your care.
If you have questions about your breast cancer risk, talk with your health care provider.
Clinical Considerations And Recommendations
How should individual breast cancer risk be assessed?
Health care providers periodically should assess breast cancer risk by reviewing the patients history. Breast cancer risk assessment is based on a combination of the various factors that can affect risk Box 1610111213. Initial assessment should elicit information about reproductive risk factors, results of prior biopsies, ionizing radiation exposure, and family history of cancer. Health care providers should identify cases of breast, ovarian, colon, prostate, pancreatic, and other types of germline mutation-associated cancer in first-degree, second-degree, and possibly third-degree relatives as well as the age of diagnosis. Women with a potentially increased risk of breast cancer based on initial history should have further risk assessment. Assessments can be conducted with one of the validated assessment tools available online, such as the Gail, BRCAPRO, Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm, International Breast Cancer Intervention Studies , or the Claus model 34.
Is screening breast self-examination recommended in women at average risk of breast cancer, and what should women do if they notice a change in one of their breasts?
Should practitioners perform routine screening clinical breast examinations in average-risk women?
When should screening mammography begin in average-risk women?
How frequently should screening mammography be performed in average-risk women?
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Breast Development And Anatomy
Most breast cancers begin in the milk ducts and the lobules, the structures containing the milk-producing glands.
Both male and female breast tissue consists of a few ducts under the nipple and areola until puberty. During puberty, females develop increased levels of certain hormones which cause these ducts to grow and lobules to form.
Males typically have low levels of these hormones, and as a result, the breast tissue does not grow as much. Although male breasts have ducts, they only have a few lobules and mainly consist of fat tissue.
What Is The Average American Womans Risk Of Developing Breast Cancer During Her Lifetime
Based on current incidence rates, 12.9% of women born in the United States today will develop breast cancer at some time during their lives . This estimate, from the most recent SEER Cancer Statistics Review , is based on breast cancer statistics for the years 2015 through 2017.;
This estimate means that, if the current incidence rate stays the same, a woman born today has about a 1 in 8 chance of being diagnosed with breast cancer at some time during her life. On the other hand, the chance that she will never have breast cancer is 87.1%, or about 7 in 8.;
For men born in the United States today, the lifetime risk of breast cancer is 0.13%, based on breast cancer statistics for the years 2015 through 2017. This means that a man born today has about a 1 in 800 chance of being diagnosed with breast cancer at some time during his life.
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Taking Charge: Who Gets Breast Cancer
There are no rules about who gets this disease. The two most significant risk factors are being a woman, and increasing age. However, there are other factors that may increase your risk, and some that may lower it.
The development of breast cancer may be influenced by factors that affect the levels of female hormones that circulate in your body throughout life. These factors include the age when you began your menstrual period, the number of times you have been pregnant, your age at first pregnancy, whether you have breastfed your children, and your level of physical activity.
Family History And Inherited Genes
Some people have a higher risk of developing breast cancer than the general population because other members of their family have had particular cancers. This is called a family history of cancer.
Having a mother, sister or daughter diagnosed with breast cancer increases the risk of breast cancer. This risk is higher when more close relatives have breast cancer, or if;a relative developed breast cancer;under the age of;50. But most women who have a close relative with breast cancer will never develop it.
Some people have an increased risk of breast cancer because they have an inherited gene fault. We know about several gene faults that can increase breast cancer risk and there are tests for some of them. Having one of these faulty genes means that you are more likely to get breast cancer than someone who doesnt. But it is not a certainty.;
Two of these faulty genes are known as BRCA1 and BRCA2. These are not common. Only about 2 out of every hundred of breast cancers are related to a change in the BRCA1 or BRCA2 genes.
Ionising radiation includes tests such as x-rays and CT scans and treatment such as radiotherapy.
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Breast Cancer: Risk Factors And Prevention
Have questions about breast cancer? Ask here.
ON THIS PAGE: You will find out more about the factors that increase the chance of developing breast cancer. Use the menu to see other pages.
A risk factor is anything that increases a persons chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.
Most breast cancers are sporadic, meaning they develop from damage to a persons genes that occurs by chance after they are born. There is no risk of the person passing this gene on to their children, as the underlying cause of sporadic breast cancer is environmental factors.
Inherited breast cancers are less common, making up 5% to 10% of cancers. Inherited breast cancer occurs when gene changes called mutations are passed down within a family from parent to child. Many of those mutations are in tumor suppressor genes, such as BRCA1, BRCA2, and PALB2. These genes normally keep cells from growing out of control and turning into cancer. But when these cells have a mutation, it can cause them to grow out of control.
The following factors may raise a womans risk of developing breast cancer:
I Almost Took Ownership Of My New Breasts’
I was diagnosed mutation BRCA2in June 2020 at the age of 39, after several breast cancers and deaths in the family, says Christine, 40. I did not want a reconstruction with prostheses, because I felt that I would not be there. comfortable with a foreign body. I turned to an immediate ablation and reconstruction with a thigh muscle, the technique best suited to my morphology. Eight hours of operation, one week of hospitalization, two surgeons for the act, one for the ablation and the second for the reconstruction, because each one has his specialty.
But things got tough once on the pool table The operation lasted 10 hours after complications, continues Christine. I had a hemorrhage during the reconstruction of the breast, which had to be stopped and which earned me 12 hours of anesthesia, hypothermia and three transfusions. And the forty-something has not yet finished hearing about surgery. Day by day, progress is there, healing is gaining ground, and after ten weeks of sick leave, I went back to work. The second operation for the breasts will be done in April 2022, for the recovery of scars and lipomodelling to improve the aesthetic appearance. For now, no regrets, I live with my scars, and I have almost made my new breasts my own.
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If You Breastfeed And How Long
Research has shown that women who breastfeed greatly lower their risk of developing breast cancer. Breastfeeding can play a role in breast cancer prevention, but the thought is, generally, the longer that you breastfeed, the greater the protective effect,” says Caudle. This could be due to the hormonal changes that happen during lactation that delay periods and limit exposure to estrogen, which can promote breast cancer cell growth, according to the experts at MD Anderson.
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Limits Of The Breast Cancer Risk Assessment Tool
The Breast Cancer Risk Assessment Tool does not use all the known risk factors for breast cancer to assess risk.
The tool also does not give a good risk estimate for some women, including those with a :
The original model was based on data from white women. The tool can now estimate risk for:
- Black women, using data from the Contraceptive and Reproductive Experiences Study
- Asian and Pacific Islander women in the U.S., using data from the Asian American Breast Cancer Study
- Hispanic women, using data from the San Francisco Bay Area Breast Cancer Study, the California Cancer Registry and the California Surveillance, Epidemiology, and End Results Program;
The model does not work as well for other racial and ethnic groups.
Visit the National Cancer Institute website to learn more about the Breast Cancer Risk Assessment Tool.