Should All Women Get A Breast Cancer Risk Assessment?

By: Lakshmi Khatri, MD • Madeline Cohn, DO • Posted on October 23, 2024

Approximately 1 in 8 women in the United States or 13% will be diagnosed with breast cancer in their lifetime. However, not all women are at equal risk. A personalized breast cancer risk assessment can be used to help estimate your probability of developing cancer and if you are at higher risk compared to others of a similar background. The result of this assessment is then used to identify those persons at highest risk who would qualify for supplemental screening or risk reducing medications.

Who can perform breast cancer risk assessments?

The good news is that you don’t need to see a breast specialist to have a breast cancer risk assessment. A primary care physician, OBGYN, women's health clinician or medical breast clinician can complete the assessment in as little as 10 minutes.

What age should women get a breast cancer risk assessment?

According to updated 2023 guidelines by the American College of Radiology (ACR), all women should undergo a breast cancer risk assessment by age 25, especially black and minority women, and those of Ashkenazi Jewish descent, as these women are at even higher risk for breast cancer.

What is included in the breast cancer risk assessment?

There are many different breast cancer risk assessment models out there, however the most commonly utilized are the Gail model and the Tyrer-Cuzik model. Both of these tools are easily accessible online and use a variety of risk factors to help calculate your likelihood of developing cancer. Risk factors are characteristics about you, whether in your control or not, which increase your risk of getting a certain disease or condition.

The Gail model (BCRAT)

The Gail model calculates a woman’s 5-year risk and lifetime risk (up to age 90) of developing invasive breast cancer. Risk factors included in the Gail model are:

Age – risk for breast cancer increases with age
Race/ethnicity – certain ethnic groups are at higher risk
Childbirth history – people who haven’t given birth are at higher risk for breast cancer
Previous breast biopsies – breast biopsies with abnormal results (such as atypical hyperplasia) are at higher risk
Age when you had your first period – starting your period at a younger age exposes you to hormones longer, increasing your breast cancer risk
Family history of breast cancer – a family history of breast cancer, particularly in first degree relatives, increases your risk

Tyrer-Cuzik model (IBIS)

The Tyrer-Cuzik model predicts a woman’s 10-year risk and lifetime risk for developing breast cancer. Risk factors included in the model are:

Age
Race/ethnicity
Breast density – women with “extremely dense” breast tissue are at increased risk
Childbirth history
Body mass index (BMI) – being obese increases your risk
Previous breast biopsies
History of ovarian cancer
Family history of breast cancer, ovarian cancer
Age when you had your first period
Age when your periods stopped/when you went into menopause – experiencing menopause at an older age increases your risk
Use of hormone replacement therapy
Knowledge of having the BRCA1 or BRCA2 mutation – having a BRCA 1 or 2 mutation significantly increases your risk

Why should a woman do a breast cancer risk assessment?

The purpose of the breast cancer risk assessment tools is to identify those at elevated risk for breast cancer who would benefit from closer screening or risk reducing medications.

Lifetime risk of 20% or greater on either the Gail or TC model

You could be a candidate for supplemental breast MRIs in addition to annual screening mammograms.
Breast MRIs are meant to be complementary to mammograms, not as a replacement, as both screening tools have their advantages when it comes to early detection.

5-year risk of 1.67% or more on the Gail model or 10-year risk of 5% or more on the TC model

You could be a candidate for taking medications that could reduce your risk for developing breast cancer.
These “risk reducing” medications include options such as tamoxifen, raloxifene, anastrozole or exemestane.
You may or may not qualify for these medications based on whether you are in menopause, your medical history or potential side effects.
A thorough shared decision-making discussion of the risks and benefits of these medications with your clinician is needed to determine which one would be best for you.

Both of these thresholds above should prompt a conversation with your clinician to determine if moving forward with these options aligns with your personal goals. The final decision to undergo supplemental screening MRIs or take risk reducing medications is ultimately up to you and your individual situation.

What if you don’t have any breast cancer risk factors?

Approximately 70% of women who develop breast cancer have no identifiable risk factors. For women of average risk, the American College of Radiology (ACR), the American College of Obstetrician and Gynecologists (ACOG) and the new 2024 United States Preventative Services Task Force (USPSTF) guidelines all agree with screening mammography starting at age 40.

ACR and the Society of Breast Imaging (SBI) recommend annual mammography screening for all average-risk women ages 40 and older and continue screening past age 74, unless severe comorbidities limit life expectancy.

Be Strong, Be Healthy, Be in Charge!
- Madeline Cohn, DO and Lakshmi Khatri, MD

About Madeline Cohn, DO

Madeline Cohn, DO is a Board Certified Family Medicine physician. She is a first year clinical Specialized Women's Health fellow at the Cleveland Clinic Center for Specialized Women's Health.

Dr. Cohn graduated with her Bachelor's degree in Psychology and Cellular and Molecular Biology from Austin College in Sherman, Texas. She attended medical school at the University of North Texas Health Science Center Texas College of Osteopathic Medicine in Fort Worth, Texas. Dr. Cohn completed her residency at Case Western Reserve University MetroHealth in Cleveland, Ohio, where she served as chief resident.

Dr. Cohn is passionate about becoming an educator and leader within the field of women's health, and she hopes to empower her patients to become advocates for their own health.

About Lakshmi Khatri, MD

Lakshmi Khatri, MD, is a Staff Member in the Department of Breast Surgery, Directory of Medical Breast Services at Cleveland Clinic. Dr. Khatri earned her medical degree from Northeastern Ohio Universities College of Medicine in Rootstown, Ohio.

She completed an internship and an internal medicine residency at University Hospitals of Cleveland and Case Western Reserve University School of Medicine in Cleveland, Ohio. Dr. Khatri is also a Diplomate of the American Board of Internal Medicine.

breast cancer, breast cancer risk, breast cancer screening, breast cancer risk assessment, breast cancer risk factors, women's health, cancer, breast cancer awareness, breast cancer awareness month, Gail model

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