The process of determining your risk of developing breast cancer sometime in the future is referred to as “risk assessment.” If you are considered to have a high risk of developing breast cancer in the future (referred to as “high risk”), then typically the following items need consideration: (a) adding yearly breast MRI scans to your yearly mammograms (because MRI will detect more cancers than a regular mammogram); (b) consultation with a breast surgeon or breast medical oncologist regarding strategies to help reduce your risk; (c) genetic testing.
Knowing your risk is important, however, the process of determining risk varies. One person can be “high risk” on one model yet be “normal risk” on another model. There are many different ways to go about the process. Typically, your risk score is calculated by entering basic information into a calculator which then produces a “risk score.” The information entered includes such things as age, family history of breast or ovarian cancer, hormone use, among other variables. Current popular models include: National Cancer Institute’s Risk Assessment Tool (Gail), BRCAPro, BOADICEA, Claus, and Tyrer-Cuzick. Typically, if your risk score is 20% or higher, then you are considered “high risk.” One thing to keep in mind: these numbers can be somewhat arbitrary. What is the real difference between a score of 19.999% and 20.001%? Typically the cut-off for high risk and low risk is chosen by a panel that weighs many factors in making a decision including a cost-benefit analysis. In other words, there can exist a superb test for detection of breast cancer, but because of cost it is restricted to a few based on certain criteria.
You often hear the phrase: “1 in 8 women will develop breast cancer.” That is a risk of 12.5% (1 divided by 8). But did you know that statistic includes only INVASIVE breast cancer? That number leaves out DCIS (a form of early breast cancer). If you include DCIS, then the phrase becomes: “1 in 6 women will develop breast cancer.” That is 17% (very close to that magic “cut off” of 20%)!! And the number would be even higher if you included precancerous cases. Note that the cure rate is almost 100% for DCIS (a form of early breast cancer)….much higher than invasive breast cancer!
So, in essence, is not EVERY woman at high risk for developing breast cancer? There is advanced technology currently available (like breast MRI) that will detect breast cancer much better and much earlier than a mammogram but it is limited to a certain few based on scientific criteria and cost-benefit analysis.
Published by Dr. Thomas Bakondy, Breast Radiologist