Using and Understanding Breast Cancer Risk Assessment Tools

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Getting routine mammograms is one of the best ways to detect breast cancer early. But now, with the availability of online breast cancer risk assessment tools, you can get even more proactive.

These tools work by asking you questions. Based on your answers, they assess your risk of getting breast cancer.

Risk calculators aren’t a substitute for seeing your doctor and having regular screenings. But understanding your personal risk can help you act faster, long before you have breast cancer symptoms.

What Are Breast Cancer Risk Calculators?

The two widely used breast risk assessment tools are:

• The Gail Model.
• The Tyrer-Cuzick model.

They’re similar in some ways but have some differences.

The Gail Model

Officially called the Breast Cancer Risk Assessment Tool (BCRAT), this tool asks about:

• History of breast cancer among your first-degree relatives (mother, sisters, daughters).
• Your health and reproductive history.

It then uses that information to calculate:

• Your five-year risk of developing breast cancer (compared to the average risk of someone of the same age and race in the U.S.).
• Your lifetime risk of developing breast cancer (also compared to the average risk of someone of the same age and race in the U.S.).

This calculator takes five minutes or less to complete.

Take the Gail Model assessment.

Tyrer-Cuzick Risk Model

Also called the International Breast Intervention Study (IBIS), this tool asks the same questions as the Gail Model. But it also asks for more specifics about your relatives and their cancer history, along with your:

• Breast density.
• Height and weight.

When you take this assessment, it gives you a breast cancer risk score, expressed as a percentage. It considers 20% high risk. If you score lower than 20%, it doesn’t classify you as high risk.

It also offers you screening recommendations. For example, even if your score is low, but you have dense breasts, it may recommend a yearly MRI.

It also explains hereditary testing and lets you know if you might qualify for insurance to cover it.

It takes five to 10 minutes to complete the Tyrer-Cuzick tool. The more first- and second-degree female relatives you have, the longer the assessment takes, because it asks about each one.

Use the Tyrer-Cuzick tool.

What Else Should I Know About My Breast Cancer Risk Assessment Score?

Neither calculator can tell you if you will get breast cancer — they can only offer you a percentage prediction.

The Gail Model can’t accurately estimate your breast cancer risk if you:

• Carry a pathogenic variant (mutation) in the BRCA1 or BRCA2 breast cancer predisposition genes.
• Have a previous history of invasive or in situ breast cancer.

Neither takes into account lifestyle factors, like your diet or how often you exercise.

What Are the Risk Factors for Breast Cancer?

Even if you score as very low risk, it’s still good to understand how breast cancer risk factors work.

“There are several risk factors that we don’t have control over,” says Emilia Diego, MD, co-director of the Breast Cancer Program at UPMC. “But it’s important to be aware of these factors in general.”

Even more important is staying aware of the risk factors you have some control over, she says.

Breast cancer risk factors you cannot change

• Age — The risk for breast cancer increases with age. Most breast cancer diagnoses occur after age 50.
• Dense breast tissue — Having dense breasts raises your risk for breast cancer. Dense breasts have more connective tissue, which can sometimes make it hard to see tumors on a mammogram.
• Family history — Having a first-degree relative (mother, sister, or daughter) or family members on either side with breast cancer increases your risk. Having a first-degree male relative with breast cancer also does.
• Gender — Women are at a higher risk for breast cancer than men, although men can get breast cancer, too.
• Genetics — The genes you inherit from your parents may put you at a higher risk of breast cancer. Having a BRCA1 gene comes with a breast cancer risk of 55% to 65%. Having a BRCA2 mutation has about a 45% risk of breast cancer.
• Personal history — If you’ve had breast cancer before, you may have a slightly higher risk of developing it a second time.
• Previous breast radiation — If you’ve had radiation therapy to the chest or breasts before age 30, you have a higher breast cancer risk.
• Reproductive history — Starting your period before age 12 and menopause after age 55 exposes you to hormones for longer, which can raise your risk. Having children later in life does, too.

Breast cancer risk factors you can change

• Breastfeeding — Although breastfeeding is a personal choice, with many factors contributing to the decision, it can lower your breast cancer risk.
• Being overweight or obese — Overweight and obese women have a higher risk for breast cancer compared to women who maintain a healthy weight. This is especially true after menopause. Being overweight can also increase your risk of breast cancer recurring (coming back) if you’ve had it before.
• Consuming alcohol — Studies show that your risk for breast cancer increases the more alcohol you drink.
• Lack of exercise — Physical inactivity increases your risk of breast cancer.
• Smoking — Younger, premenopausal women who smoke are at a higher risk of breast cancer. There is a possible link between heavy secondhand smoke exposure and breast cancer risk in postmenopausal women.
• Taking hormones — If you take an estrogen-progesterone hormone during menopause for five or more years, it may raise your risk. Certain birth control pills may also increase breast cancer risk. Discuss the pros and cons of each option with your doctor.

Getting Screened for Breast Cancer

Knowing your risk helps you know what screening is best for you, as well as how often that screening is necessary.

“Getting a yearly clinical breast exam by a doctor or an advanced practice provider is very important,” Dr. Diego says.

The general recommendation is to start getting screening mammograms at age 40. “But you should have a conversation with your doctor about when the right time is for you,” she says.

Depending on your risk percentage, you may need other tests besides a mammogram, such as an ultrasound or MRI. To find out if you have a BRCA gene, your doctor can help schedule a test or refer you to a genetics counselor.