This week, actress Olivia Munn shared that she was diagnosed and treated for breast cancer last 12 months, and that a risk calculator helped her doctor detect the cancer early.
“Ask your doctor to calculate your breast cancer risk score,” Ms. Munn urged in her post.
Medical experts are enthusiastic about risk calculators, but caution that the outcomes are only rough estimates and must be interpreted with the assistance of a health care provider. Here’s what you need to know.
What do breast cancer risk calculators bear in mind?
ABOUT one in eight women will develop breast cancer during their lifetime. But tools just like the one Ms. Munn’s doctor used can provide a more personalized picture of a person patient’s risk.
There are two major calculators: Breast Cancer Risk Assessment Toolalso referred to as the Gaila model, and Tyrer-Cuzick risk assessment calculator, also called the IBIS model. Both ask users about their age, race, ethnicity, family history of breast cancer, after they first began menstruating, and in the event that they have children, how old they were after they had their first child. All of those aspects can affect an individual’s risk of breast cancer.
The IBIS calculator also asks for information about the person’s biopsy history, breast density, and the age at which any member of the family was diagnosed with breast cancer.
The calculators compare an individual’s responses with the typical responses of other women of the identical age and racial group, then use that data to estimate their five-year and lifelong risk of developing breast cancer.
Although breast cancer can even occur in men, the tools only calculate the risk for girls. Gail’s model cannot accurately calculate risk for girls with a history of invasive breast cancer or ductal carcinoma in situ, or for girls with mutations within the BRCA1 or BRCA2 genes that increase the risk of breast cancer, said Sandhya Pruthi, M.D., M.D. breast Mayo Clinic Comprehensive Cancer Center. Accuracy can also vary amongst different racial groups. “These things were originally built around Western European women,” said Dr. Otis Brawley, associate director of outreach and engagement on the Sidney Kimmel Comprehensive Cancer Center.
According to the National Cancer Institute, the Gail calculator may underestimate the risk in black women who’ve had a biopsy and Latina women born outside the United States. It can also be inaccurate for American Indians or Alaska Natives because data on their risk is restricted. Black women can ask their doctors about this Black Women’s Health Screening Calculatorwhich was developed using data from Black women within the United States.
“It is also essential to ensure that you understand the data required to answer the questionnaires and that you have entered it correctly,” Dr. Pruthi said. Even small changes in responses may end up in very different risk assessments. Experts noted that these calculators must be used as a part of more comprehensive care, including regular doctor visits and really useful screening tests akin to mammograms. They can also be useful for girls who should not yet sufficiently old to have routine mammograms.
How do you interpret the risk assessment?
Breast cancer risk calculators must be used as a conversation starter together with your health care provider, says Dr. Nancy Chan, oncologist and director of breast cancer clinical research on the Perlmutter Cancer Center at NYU Langone. Knowing your estimated risk may also help you and your doctor discuss whether you may need more frequent mammograms or genetic testing, or whether specific preventive steps may also help reduce your risk.
“If the risk is high, we can do something about it,” she added. Doctors may recommend that ladies with a high rating make sure lifestyle changes – akin to increasing physical activity, cutting down on smoking and limiting alcohol consumption – or that ladies with a high five-year risk take medicines that may also help reduce the risk of breast cancer.
Doctors warn, nonetheless, that interpreting the outcomes on your individual could also be difficult. In particular, the difference between five-year risk assessment and lifelong risk may be difficult to understand, Dr. Brawley said.
“One of the things I worry about is that a woman who takes the test will find that she has a lower than average risk of breast cancer – say a lifetime risk of 7 percent – and decide, ‘Oh, then I don’t need to get tested.” to a high-quality routine screening program,” Dr. Brawley said. Other women may have a higher risk score, which, if interpreted without other context, could lead to over-testing or unnecessary anxiety.
“You don’t need people to just have a look at these numbers and get too scared,” said Dr. Steven Woloshin, a professor of medicine at Dartmouth University who has studied overdiagnosis.
Risk assessment does not determine whether a person will develop breast cancer or not. And it doesn’t say anything about your chances of dying from the disease, Dr. Woloshin said.
Dr. Pruthi says other risk assessment tools are being developed that could help doctors make even better predictions in the future. “Where we really want to be one day is personalized risk,” she said. “What new information can we add that is more unique to you?”
