Risk Assessment Models for Breast Cancer

• The Gail model:
  • Which is based on:
    • Age
    • Race/ethnicity
    • Age at menarche
    • Age at first live birth
    • Number of prior breast biopsies
    • Personal history of atypical hyperplasia
    • Family history of breast cancer in first-degree relatives
  • The Gail model does not address and is not appropriate:
    • For patients with LCIS
• The Tyrer-Cuzick model:
  • Incorporates:
    • Age
    • Nulliparity
    • Family history
    • LCIS
    • BMI
    • Age at menarche
    • Age at menopause
    • Hormone replacement therapy use
    • Prior breast biopsies
  • However, while the Tyrer-Cuzick model does incorporate personal history of atypical ductal hyperplasia and LCIS:
    • Data has emerged showing that this model:
      • Appears to overestimate risk
      • Has poor concordance among populations of women with high-risk breast lesions
  • This model does not accurately predict invasive breast cancer risk:
    • Should be avoided even it may be the most accurate in assessing risk secondary to family history:
      • Among women with LCIS
  • Breast cancer risk among women with LCIS:
    • Has been shown to be approximately 2% per year and modified by volume of LCIS
• BRCAPRO and BOADICEA:
  • Are both Mendelian models that estimate breast cancer risk:
    • Based on the probability that the individual carries a mutation in a major breast cancer susceptibility gene:
      • Such as BRCA1 or BRCA2
  • The BOADICEA model incorporates 3rd-degree relatives
  • Whereas the BRCAPRO only incorporates 1st- and 2nd-degree relatives
  • Neither of these models incorporate nulliparity or LCIS into the calculation

• References:
  • Gail MH, Brinton LA, Byar DP, Corle DK, Green SB, Schairer C, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81(24):1879-1886.
  • Tyrer J, Duffy SW, Cuzick J. A breast cancer prediction model incorporating familial and personal risk factors. Stat Med. 2004;23(7):1111-1130. [See comment in Stat Med. 2005;24:1610-1612; erratum appears in Stat Med. 2005;24:156].
  • Valero M, Zabor E, Park A, Gilbert E, Newman A, King TA, et al. The Tyrer-Cuzick Model inaccurately predicts invasive breast cancer risk in women with LCIS. Ann Surg Oncol. 2020;27(3):736-740.
  • Boughey JC, Hartmann LC, Anderson SS, Degnim AC, Vierkant RA, Reynolds CA, et al. Evaluation of the Tyrer-Cuzick (International Breast Cancer Intervention Study) model for breast cancer risk prediction in women with atypical hyperplasia. J Clin Oncol. 2010;28(22):3591-3596.
  • King TA, Pilewskie M, Muhsen S, Patil S, Mautner SK, Park A, et al. Lobular carcinoma in situ: a 29-year longitudinal experience evaluating clinicopathologic features and breast cancer risk. J Clin Oncol. 2015;33(33):3945-3952.
  • Berry DA, Parmigiani G, Sanchez J, Schildkraut J, Winer E. Probability of carrying a mutation of breast-ovarian cancer gene BRCA1 based on family history. J Natl Cancer Inst. 1997;89(3):227-238.
  • Antoniou AC, Pharoah PP, Smith P, Easton DF. The BOADICEA model of genetic susceptibility to breast and ovarian cancer. Br J Cancer. 2004;91(8):1580-1590.

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