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What is the Gail model?
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ThereseBeversMD (Physician - Family Medicine (Verified) ) - 06 / 28 / 2012
The Gail model, also called the National Cancer Institute (NCI) Breast Cancer Risk Assessment Tool, is a computerized tool that estimates a woman’s risk of developing breast cancer. This program is available online at the NCI website (www.cancer.gov/bcrisktool) or at www.breastcancerprevention.com.
Risk factors used in the Gail model include age, age at menarche (when a woman started her menstrual cycle), age at first live birth (or never having a full-term pregnancy), family history of breast cancer in first-degree relatives (mother, sister or daughter), history of breast biopsy and if any biopsies identified atypical hyperplasia. Because the incidence of breast cancer differs by race, the current, modified version of the Gail model includes race-specific incidence data. The program prompts the user to input information about each of the risk factors and provides a printout showing projected breast cancer risk in the next 5 years and projected lifetime risk. For comparative purposes, the printout also includes the average 5-year and lifetime risk for a woman of the same age as the woman evaluated. Increased risk is defined as a 5-year calculated risk of 1.7% or greater. This is the average risk of a 60-year-old woman which was the median age of diagnosis of breast cancer in the United States at the time the model was developed.
The NCI Breast Cancer Risk Assessment Tool does not estimate risk for women known to be at increased risk of breast cancer based on a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS) or prior thoracic radiation therapy to the chest for treatment of Hodgkin’s lymphoma. In addition, it uses only a limited number of risk factors and does not take into account such risk factors as current or former use of hormone therapy or breast density. The model does not consider any paternal family history, maternal family history other than first-degree relatives, personal or family history of ovarian cancer or other familial factors of concern for an inherited mutation such as male breast cancer, bilateral breast cancer in a relative and an early age of diagnosis of breast cancers in the family. As a result, the model may significantly underestimate breast cancer risk, especially for women with a genetic predisposition (e.g., BRCA1 or BRCA2). For these reasons, the risk calculation cannot be taken outside of the context of the patient’s overall personal and family history.
Women without a personal history of breast cancer, DCIS, LCIS, prior thoracic radiation or a strong family history should ask their doctor to calculate their risk of breast cancer using the Gail model. If the 5 year risk is 1.7% or greater, the woman can be considered for tamoxifen or raloxifene to reduce her breast cancer risk.
Risk factors used in the Gail model include age, age at menarche (when a woman started her menstrual cycle), age at first live birth (or never having a full-term pregnancy), family history of breast cancer in first-degree relatives (mother, sister or daughter), history of breast biopsy and if any biopsies identified atypical hyperplasia. Because the incidence of breast cancer differs by race, the current, modified version of the Gail model includes race-specific incidence data. The program prompts the user to input information about each of the risk factors and provides a printout showing projected breast cancer risk in the next 5 years and projected lifetime risk. For comparative purposes, the printout also includes the average 5-year and lifetime risk for a woman of the same age as the woman evaluated. Increased risk is defined as a 5-year calculated risk of 1.7% or greater. This is the average risk of a 60-year-old woman which was the median age of diagnosis of breast cancer in the United States at the time the model was developed.
The NCI Breast Cancer Risk Assessment Tool does not estimate risk for women known to be at increased risk of breast cancer based on a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS) or prior thoracic radiation therapy to the chest for treatment of Hodgkin’s lymphoma. In addition, it uses only a limited number of risk factors and does not take into account such risk factors as current or former use of hormone therapy or breast density. The model does not consider any paternal family history, maternal family history other than first-degree relatives, personal or family history of ovarian cancer or other familial factors of concern for an inherited mutation such as male breast cancer, bilateral breast cancer in a relative and an early age of diagnosis of breast cancers in the family. As a result, the model may significantly underestimate breast cancer risk, especially for women with a genetic predisposition (e.g., BRCA1 or BRCA2). For these reasons, the risk calculation cannot be taken outside of the context of the patient’s overall personal and family history.
Women without a personal history of breast cancer, DCIS, LCIS, prior thoracic radiation or a strong family history should ask their doctor to calculate their risk of breast cancer using the Gail model. If the 5 year risk is 1.7% or greater, the woman can be considered for tamoxifen or raloxifene to reduce her breast cancer risk.
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