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Using Risk Assessment Tools

There are several credible online tools available to help you and your health care provider better understand your breast cancer risk and inform your decision-making about breast cancer risk reduction as well as screeningScreening:
The search for diseases such as breast cancer in people without symptoms. Mammography is an important tool for breast cancer screening and earlier detection.
options for the earlier detection of breast cancer. 

No tool can predict whether or not you will develop breast cancer. However, risk assessment tools can help you gain a more thorough understanding of what breast cancer risk factorsRisk factor:
Anything that increases a person’s chance of developing a disease, such as cancer.
are and what they mean for your health. Risk assessment tools use your risk factors to estimate your personal risk of developing breast cancer over a period of time (e.g. 10 years), or over your lifetime.

These tools have strengths and limitations. Most importantly, no single tool takes all of the known breast cancer risk factors into account.  This means that each tool can only provide an estimation of risk based on the risk factors it assesses.

As no single tool gives a complete and comprehensive assessment of breast cancer risk, think about the results alongside other sources of information. Canadian Breast Cancer Foundation encourages you to consider having a conversation with a health care provider to help you understand your personal breast cancer risk, ways to reduce the risk, and your screening options to detect breast cancer earlier. 

Using Online Risk Assessment Tools: Things To Consider

Some online tools have been created to help the public learn more about breast cancer risk. You may have come across some of these tools on the Internet. A well-designed tool can provide you with an indication of your risk of developing breast cancer, based on the risk factors included in the tool.

If you use an online breast cancer risk assessment tool, please consider the following:

  • Use a tool that has been developed by a credible and trustworthy source (e.g. a recognized research body, academic institution, health charity or government).

  • The tool should provide you with information about how it was developed and its benefits and limitations, including what it can tell you about breast cancer risk and what it cannot tell you. Look for this information and read it before you use the tool. This can help you to better understand the tool and its results.

  • Base your health decision-making on information from different, credible sources and consider using what you’ve learned to inform a conversation with a health care provider.

Risk Assessment Tools For The General Public

Your Disease Risk is an educational website with a risk assessment tool that allows you to estimate your risk for developing several diseases, including breast cancer. The tool estimates your breast cancer risk as being “above average,” “average,” or “below average” compared to the general population, based on a comprehensive set of breast cancer risk factors. It also provides suggestions for ways to reduce your risk of developing breast cancer based on your specific risk factors. You may wish to discuss your results with a health care provider as part of a conversation about your breast health.

How the tool works

 Your Disease Risk estimates breast cancer risk based on the following factors:

Limitations
  • The tool considers limited information about family breast cancer history, which could underestimate risk

  • The tool was developed using data for the United States and estimates your risk relative to the U.S. general population. It may be applicable to populations in other high-income countries, such as Canada, but estimations of risk in other populations may be unreliable.

 


Risk Assessment Tools Used By Health Care Professionals

The following section provides an overview of some of the risk assessment tools used by health care providers and genetic counsellorsGenetic counsellor:
A health care provider with specialized training and experience in the areas of medical genetics and counselling.
to estimate breast cancer risk.

Many of these tools are available online and accessible to the public. If you choose to explore these tools to learn more about your breast cancer risk, discuss your results with a health care provider, who can help you understand what the risk that is calculated means for you. 

Gail Model – National Cancer Institute

The Gail model is used to estimate a woman’s risk of developing invasiveInvasive (breast cancer):
Cancer that spreads from where it started in the breast (i.e., the breast ducts or lobules) into surrounding, healthy breast tissue.
breast cancer over specific periods of time. Health care providers may use this model to assess breast cancer risk, inform decision-making about chemopreventionChemoprevention:
The use of drugs or other agents to try to prevent or delay the onset of cancer or its recurrence.
strategies, or to help determine eligibility for clinical trialsClinical trial:
One of the most common types of experimental studies in humans is the clinical trial. Clinical trials are designed to test new ways to prevent, detect, and treat specific diseases.
.

How the tool works

The Gail model considers the following factors to assess breast cancer risk:

Limitations
 
 

The Breast Cancer Risk Assessment Tool is based on the Gail model. This online tool estimates a woman’s risk of developing invasive breast cancer over a 5-year time period and over her lifetime.   

How the tool works

The tool estimates breast cancer risk based on the following risk factors: 

  • Age

  • Age at first period

  • Age at first live birth of a child

  • Family history of breast cancer

  • Personal history of breast cancer

  • Number of past breast biopsies, including number of breast biopsies that showed atypical hyperplasia (a precancerous condition that increases breast cancer risk)

  • Race/ethnicity

When you use the tool, its score provides an estimate of the average risk for a group of women with similar risk factors.
  • For example, if the tool gives you a score of 1.7%, this means that an estimated 1.7% of women with similar risk factors will develop breast cancer in the next 5 years.  

RESULTS:  A 5-year risk of 1.67% or higher is considered high risk for developing breast cancer.

Limitations

  See above. This tool has all of the limitations of the Gail model

 

Tools To Identify People At Higher Breast Cancer Risk

If you think you may be at a higher risk of breast cancer, there are tools that cover a more comprehensive family cancer history. They are used to help assess individual breast cancer risk and to inform decision-making about genetic counselling and testing. 

IBIS Breast Cancer Risk Evaluation Tool 

The IBIS tool (also called the Tyrer-Cuzick model) is used to calculate a person’s likelihood of carrying the BRCA1 or BRCA2 mutations, which are associated with increased breast cancer risk. It estimates the likelihood of a woman developing breast cancer in 10 years and over the course of her lifetime. The tool is used to help inform a person’s decision-making about genetic counselling and testing.


How the tool works

The tool estimates breast cancer risk based on the following risk factors:

  • Age

  • Age at first live birth of a child

  • Age at first period

  • Age at menopause

  • Height and weight

  • Being diagnosed with a benign breast condition that increases breast cancer risk

  • Use of hormone replacement therapy

  • Comprehensive family history  

RESULTS: Genetic counselling is advised when the model predicts a 10% or greater chance that the person has a mutation of the BRCA1, BRCA2, or both genes.

Limitations

The tool does not include risk factors or prevention factors associated with lifestyle or breast density

 

Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) 

The BOADICEA is a model used to calculate the risks of breast and ovarian cancer in women. It calculates the probability that a woman is a carrier of any cancer-associated mutations in the BRCA1 or BRCA2 gene.  It also estimates the likelihood of a woman developing breast cancer in 5 years, and over the course of her lifetime. The tool is used to help inform a woman’s decision-making about genetic counselling and testing.

How the tool works

The tool estimates breast cancer risk based on:

  • Family cancer history

  • Genetic mutation status

RESULTS: A decision to go for genetic counselling is usually made when the model predicts a 10% or greater chance that the patient has a mutation of the BRCA1, BRCA2, or both genes.

Limitations
  • The major limitation of this tool is that it only considers genetic mutation status and family history.  It does not take any other breast cancer risk factors into account. 

  • The tool was developed using data for the United Kingdom.  It may be applicable to populations in other high-income countries, however estimations of risk in other populations may be unreliable.

 


Sources:

Centre for Cancer Genetic Epidemiology. BOADICEA. Accessed June 23, 2014.

Cuzik, J. IBIS tool. Accessed June 23, 2014.

National Cancer Institute. Breast Cancer Risk Assessment Tool. Accessed June 23, 2014.

Siteman Cancer Center. Your Disease Risk – Breast Cancer. Accessed June 23, 2014.