Risk Assessments Models in Breast Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • 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, and family history of breast cancer in first-degree relatives:
      • Does not address and is not appropriate for patients with lobular carcinoma in situ (LCIS)
  • The Tyrer-Cuzick model:
    • Incorporates age, nulliparity, family history, and LCIS
    • In addition, the Tyrer-Cuzick model incorporates:
      • BMI, age at menarche, age at menopause, hormone replacement therapy use, and 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 and has poor concordance among populations of women with high-risk breast lesions
    • This model does not accurately predict invasive breast cancer risk and should be avoided even if 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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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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