According to the National Cancer Institute, breast cancer risk assessment, or assessing a patient's risk for breast cancer, identifies risk and estimates probability of breast cancer allowing appropriate preventive screening and risk reduction procedures. Tools for conducting risk assessment ideally need to be accurate, applicable to the particular patient population, and quick to conduct. Breast cancer risk assessment tools have advanced to computer based algorithms and online survey instruments.
NCI Breast Cancer Risk Assessment Tool
Developed by the National Cancer Institute (NCI) and the National Surgical Adjuvant Breast and Bowel Project (NSABP), the Breast Cancer Risk Assessment Tool bases off the Gail risk assessment model and focuses primarily on nonhereditary risk factors. The Gail model, named after Dr. Mitchell Gail of NCI, uses statistics to derive risk.
The NCI tool assumes the woman lives in the United States and receives breast cancer screening. Available online, the tool has 7 questions, and literally within seconds generates a 5-year risk for breast cancer and a lifetime risk. Although updated to provide better calculation for African-American women, the tool continues to only calculate breast cancer risk for women who have not had a diagnosis of breast cancer. Further, for women with a family history of breast cancer, this tool will not provide an accurate risk.
Your Disease Risk
Created by the Harvard Center for Cancer Prevention, another online tool called Your Disease Risk takes more lifestyle and family history factors into account. Slightly longer to conduct than the NCI model but easy to navigate, it provides a 5-year risk and a lifetime risk within seconds. The results present in a colored bar graph and describe in text and in visual how to reduce breast cancer risk based on the factors provided.
BOADICEA
Few online tools calculate risk of breast cancer for women who have already had breast cancer. The Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) performs such calculation, and best predicts cancer risk for women with family history of breast cancer. Cumbersome to use, it takes much longer to conduct and suits best for use in a cancer or genetics clinic.
Other Tools
Other online tools exist for predicting breast cancer risk. Most base off the Gail model. The Claus model, not online, predicts breast cancer risk taking into account maternal and paternal family history of breast cancer.
A number of risk assessment models assess risk for inheriting a gene mutation in the BRCA1 or BRCA2 genes. These computer risk assessment models calculate the risk of inheriting a genetic mutation. Some also give a risk for developing breast cancer. Models include BOADICEA, BRCAPRO, Tyrer-Cuzick, Penn II, and others. Specialized cancer genetic clinics use these models to determine utilization of genetic testing.
These models also determine MRI breast screening eligibility. The American Cancer Society's recommendations suggest using the BRCAPRO, Claus, or Tyrer-Cuzick models. Additionally, the National Instituite for Health and Clinical Excellence recommends using BOADICEA among breast cancer patients.
References
- National Cancer Institute: Cancer Risk: Understanding the Puzzle
- National Cancer Institute: Breast Cancer Risk Assessment Tool
- Siteman Cancer Center: Your Disease Risk: Breast Cancer
- Panchal SM, Ennis M, Canon S, Bordeleau LJ. Selecting a BRCA risk assessment model for use in a familial cancer clinic. BMC Med Genet. 2008 Dec 22;9:116.
