Breast Cancer Risk Assessment Tool: The Gail Model
The National Cancer Institute (NCI) has developed a computer-based tool to allow clinicians to estimate a woman’s risk of developing invasive breast cancer over the next 5 years and in their lifetime (up to age 90). Thetool is based on a mathematical model of breast cancer risk cal-culation called the Gail Model. Seven risk factors are usedin the calculations: a history of LCIS or DCIS, age, age at onset of menstruation, age at time of the first live birth, number of first-degree relatives with breast can-cer, history of breast biopsy, and race/ethnicity. The use-fulness of the Gail model is limited in patients with second-degree relatives with breast cancer (eg, paternal transmission) and is falsely increased in patients with multiple breast biopsies.
Women at high risk, defined as a 5-year risk of 1.7% or more, can be referred for possible prophylactic therapy. Current prophylactic options include chemoprevention with the selective estrogen receptor modulators tamoxifen and raloxifene, and prophylactic mastectomy. Since all of the options areassociated with significant side effects, individualized risk assessment should be performed to determine whether a patient is a candidate for breast cancer risk reduction and, if so, which option is best.