BREAST CANCER RISK ASSESSMENT

YOUR HEALTH IS IN YOUR HANDS: Take 1 minute to learn your personal cancer risk and get
simple steps to take charge of your breast  
health.

 Know Your Risk

Did you know that 1 in 8 women will be diagnosed with breast cancer in her lifetime? While you can’t prevent cancer, it is important to be proactive about your health.

The BREAST CANCER RISK ASSESSMENT helps you protect your overall health and assess your breast cancer risk and Lifetime Risk (LTR) of developing breast cancer

There are several breast cancer risk assessment tools that doctors use to calculate a woman’s risk of breast cancer. One of the most well-known is the Claus Model, which assesses breast cancer risk based.

 

Identifying  Women Who Meet Criteria for High-Risk Screening MRI

Current American Cancer Society guidelines  recommend annual screening MRI beginning by age 25 to 30 in women who have a lifetime risk (LTR) of breast cancer of 20 to 25% or more. Any of the models used to predict risk of a pathogenic mutation, or the Claus model,  can be used to estimate lifetime risk for purposes of screening MRI guidelines. Annual screening MRI is also recommended in women who are known to carry pathogenic mutations in BRCA1 or BRCA2 (unless the woman has had bilateral mastectomy), and in women who are first-degree relatives of known mutation carriers but who are themselves untested.

At Advanced Women’s Imaging, we use the Claus Assessment Tools, designed to predict an individual’s lifetime risk of developing breast cancer. Not all tools can be appropriately applied to all patients. Each tool is most effective when the patient’s characteristics and family history are similar to those of the study population on which the tool was based.

With the Claus model, lifetime breast cancer risk estimates are based on family history. The Claus model considers the number and ages of onset of breast cancer in first- and second-degree relatives. It also distinguishes between maternal and paternal relatives.

What it tells you: The patient’s 5 years and lifetime risk to develop breast cancer. Remaining risk based on age is also calculated and displayed at 5-year increments using interpolation.

What it takes into account: Family history of breast cancer and ages of cancer diagnoses. The original model developed in 1991 only took into account a family history of breast cancer; later versions took into account ovarian cancer data. An expanded Claus model developed in 2004 also take into account bilateral breast cancer and risks for three or more affected relatives.

If the lifetime risk is greater than 20 percent using the Claus model, the patient qualifies for high-risk surveillance, according to the American Cancer Society. Women at elevated risk (≥ 20% lifetime) for breast cancer should be offered annual screening breast magnetic resonance imaging in addition to mammography.

The Breast Cancer Risk Assessment Tool

The Breast Cancer Risk Assessment Tool allows patients to estimate the risk of developing invasive breast cancer over the next 5 years and up to age 90 (lifetime risk).

The tool uses a woman’s personal medical and reproductive history and the history of breast cancer among her first-degree relatives (mother, sisters, daughters) to estimate absolute breast cancer risk—her chance or probability of developing invasive breast cancer in a defined age interval.

Several breast cancer risk assessment tools have been developed that combine known major risk factors. Risk models either predict the risk of a pathogenic mutation in BRCA1 or BRCA2, risk of developing invasive breast cancer, or both. Risk models can be useful in stratifying patients into risk categories to facilitate personalized screening and surveillance plans for clinical management of the patient.

Lifetime Risk (LTR) of developing breast cancer

Occurrence(s) of breast cancer in first-degree and second-degree female relative(s) by decade age of diagnosis

MRI screening (for 20% lifetime risk threshold)

 

“Mammograms miss over 50% of cancers in women with the densest breasts, so offering them only mammography for breast cancer screening is discriminatory. Women with dense breasts deserve the same opportunity for early detection of breast cancer, as women with non-dense breasts.” Paula B Gordon, Radiologist, Clinical Professor, University of British Columbia

Why is It Important to have a Breast MRI?

  • About half of women over 40 have dense breasts; about 10% have very dense ones. That raises their risk of cancer and makes it harder to spot on mammograms. Researchers studied different scanning methods on 40,000 Dutch women aged 50 to 75 with very dense breasts. MRI scans spotted more cancers than any other type of screening.

Dense breasts are associated with 2 important risks: the risk that cancer will be masked on the mammogram and the increased risk of getting breast cancer. Mammograms miss over 50% of cancers in women with the densest breasts, so offering them only mammography for breast cancer screening is discriminatory. Women with dense breasts deserve the same opportunity for early detection of breast cancer, as women with non-dense breasts. Women at elevated risk (≥ 20% lifetime) for breast cancer should be offered annual screening breast magnetic resonance imaging in addition to mammography.

Large scale supplemental screening with ultrasound in Connecticut (the first state to mandate density notification) shows 3-4 cancers per thousand women screened, and these ultrasound-detected cancers are almost all small, invasive and node negative. NOT DCIS, which arguably may be “overdiagnosed.”

If those cancers go undetected, they grow until they are detected by palpation, as “interval cancers,” which are larger at diagnosis and more often node-positive than screen-detected cancers. They tend to be higher nuclear grade, and more aggressive with a greater predominance of HER2 and triple negative molecular subtypes. They have a poorer prognosis compared to screen-detected cancers.

Research from Italy showed that the highest Breast Density category, compared with the other three together, had double the invasive BC risk, 5X the risk of an interval cancer, and almost fourfold risk of advanced cancer.

How to Calculate your Risk?

To calculate your risk score please use the drop-down boxes to indicate your age and the ages of your relatives at the time of diagnosis for breast or ovarian cancer and then press  “What’s my risk?” button.

 

The information in this document does not replace a medical consultation. It is for personal guidance use only. We recommend that patients ask their doctors about what tests or types of treatments are needed for their condition.

References:

Claus EB, Risch N, Thompson WD. Autosomal dominant inheritance of early-onset breast cancer. Implications for risk prediction. Cancer 1994; 73:643-651

http://www.ncbi.nlm.nih.gov/pubmed/19569248 and http://www.ncbi.nlm.nih.gov/pubmed/16288118

 
Maternal Grandmother
Maternal Grandfather
Mother
Maternal Aunt
Maternal Aunt
Sister
Maternal Sister's Daughter
Maternal Sister's Daughter
Daughter







Patient
 
Paternal Grandmother
Paternal Grandfather
Father
Paternal Aunt
Paternal Aunt
Sister
Paternal Sister's Daughter
Paternal Sister's Daughter
Daughter
Based on your family history, you do not have an elevated (20% or greater) risk of developing breast cancer. It is recommended that you follow the American College of Radiology's Recommendations for Breast Cancer Screening for Women of Average Risk:
  • Women age 40 and older (who have no symptoms) should have an annual mammogram
  • Screening with mammography should continue as long as the woman is in good health and is willing to undergo additional testing (including biopsy) if abnormality is detected
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