Clinical Implementation of a Breast Cancer Risk Assessment Program in a Multiethnic Patient Population: Which Risk Model to Use?

Abstract

The integration of risk assessment into clinical breast screening holds promise in increasing health care efficiency and decreasing morbidity and mortality associated with breast cancer diagnosis. While the National Cancer Comprehensive Network recommends risk counseling and increased screening for women with a 5-year risk of ≥1.7% based on the Gail model or other risk model (1,2), the US Preventive Services Task Force recommends that women who are at increased risk for breast cancer and at low risk for adverse medication effects be offered risk-reducing medications, such as tamoxifen or raloxifene, by their clinicians (3). However, neither recommendation clearly specifies which risk model to use; rather, they mention a number of different risk models. Thus, clinicians seeking to integrate breast cancer risk assessment into their practice are faced with uncertainty on how to assess risk in their patients.Concerns have been expressed regarding the limited clinical applicability of the Gail model (4,5). In addition, the Gail model does not consider some established risk factors, including breast density, obesity, and hormone use. We sought to determine the potential impact of adding two other models, the Breast Cancer Surveillance Consortium (BCSC) and the Tyrer-Cuzick models, on assessing screening mammography patients' breast cancer risk in the University of California, Irvine (UCI) Athena Breast Health Network Risk Assessment Program (6).After obtaining approval by the UCI Institutional Review Board, 3,426 research participants were recruited from the risk assessment program between March 2011 and January 2014. For this pilot study, a sample of 325 research participants were consecutively selected starting with the most recent enrollment date, based on age and race/ethnicity, resulting in~25% between 40-49, 50-59, 60-69, and 70-79 in each of the three most populous race/ethnicity categories in our patient population: non-Hispanic White, Hispanic, and Asian. Patients who met exclusionary criteria for the Gail, BCSC, or Tyrer-Cuzick models were excluded, resulting in 307 participants in our analytic pilot study cohort. All data except breast density data were obtained from the Athena Breast Health Questionnaire, which also served as an electronic intake form for the patients. Breast density data, categorized as BIRADS 1-4, were extracted from radiologist-dictated mammogram reports accessed through patients' electronic medical records. The data were used to calculate each patient's breast cancer risk scores using three risk assessment tools: (a) the Breast Cancer Risk Assessment Tool (www.cancer.gov/bcrisktool), based on the modified Gail model (7); (b) the BCSC Risk Calculator (tools.bcsc-scc.org/BC5yearRisk) (8); and (c) the IBIS Breast Cancer Risk Evaluation Calculator (www.ems-trials.org/riskevaluator), which calculates Tyrer-Cuzick scores (9). The distinct and overlapping risk factors considered in each of these models are depicted in Figure 1.As expected, the average risk scores for White women (1.66-1.86%) w...

Outcomes of women at high familial risk for breast cancer: An 8‐year single‐center experience

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Factors Associated with Women’s Unwillingness to Decrease Alcohol Intake to Decrease Breast Cancer Risk

“…Study participants were recruited from the UCI Athena Breast Health Network (Athena). 24 The UCI Athena cohort is an ongoing cohort started in 2011 comprised of women 18 years and older who completed an electronic clinical intake form when they received a screening mammogram at a UCI breast imaging facility and provided informed consent to share their intake data for research purposes. Some participants also indicated they were willing to be contacted for future studies.…”

Breast Cancer Risk Prediction in Korean Women: Review and Perspectives on Personalized Breast Cancer Screening

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