How is your risk of breast cancer? Let's talk about this (Breast Cancer Risk Assessment)!

How are you? Today we're going to talk about a topic that's very important to many women, and a little scary. That's breast cancer risk assessment. Don't worry, this can't tell you for sure whether you have cancer or not. But it can help you understand what your risk is.

What is Breast Cancer Risk Assessment?

Simply put, this is a way to look at your chances, or probability, of developing breast cancer in your lifetime. For example, in some countries, about one in eight women will develop breast cancer in their lifetime. So, this assessment can help you get a rough idea of ​​whether you are among them, or whether your risk is higher or lower than the average person.

The important thing is, this doesn't say "you will get cancer" or "you won't." It just shows how much risk you have compared to others your age and background. Currently, these methods are designed for women. They are not used to measure the risk of breast cancer in men.

How do these risk assessment models work?

There are currently about twenty-four such risk assessment methods. Most of these are available as online questionnaires. You can answer these questions in as little as ten minutes. Based on your answers, a score is calculated based on your risk factors . A risk factor is something that increases your chance of developing a disease, especially breast cancer, at this time.

So what are these main risk factors?

Let's see what things can increase the risk of breast cancer.

• Age: The risk of breast cancer gradually increases with age.
• Family history of breast cancer: If a close family member (first-degree relative), such as your mother, sister, or daughter, has had breast cancer, or if several family members have had it, your risk is higher.
• Genetic mutations: Some people may have certain changes in their genes. In particular, mutations in the genes `(BRCA1)` and `(BRCA2)` significantly increase the risk of breast cancer.
• Race/ethnicity: Some ethnic groups are at higher risk. For example, people of Ashkenazi Jewish descent are more likely to have mutations in the `(BRCA1)` or `(BRCA2)` genes, which means they are at higher risk of breast cancer.
• Breast density: Some women have more fibrous and glandular tissue in their breasts and less fatty tissue. People with dense breasts are at higher risk than those with more fatty tissue.
• Previous breast biopsies: If you have had a previous breast biopsy and the results showed abnormal cell growth, such as atypical hyperplasia , your risk is higher.
• Hormone exposure: Having high levels of the hormones estrogen and progesterone in your body for a long time increases your risk. This can be due to hormones that your body produces naturally (related to menstruation), or it can be due to certain medications you take. For example, some birth control pills and hormone replacement therapy (HRT) can also increase your risk.
• Age at menarche: If you started puberty at a very young age (menarche) , it means your body has been exposed to hormones for a long time. This also increases your risk.
• Age at menopause: Also, if your period, or menopause , occurred later than normal, your risk increases due to the longer exposure to hormones.
• Childbirth history: Women who have never had any children are at higher risk than those who have. This is because they have more menstrual cycles and are exposed to hormones for longer periods of time. Also, if you have had a child, especially if you had your first child before age 35 , your risk of breast cancer is lower. The more children you have, the lower the risk is for each child.

But remember, not all of these risk factors are equally important. For example, while the risk increases slightly with age, someone with a ``(BRCA1)`` gene mutation can have a 60% higher risk of developing breast cancer. Even one of these factors can put you in the high-risk category.

Different risk assessment methods consider these factors differently and give them different weightings. Let's look at some of the most commonly used methods.

What are the most commonly used risk assessment models?

Although there are various methods, we will talk about a few main ones.

1. Gail model (Gail model - BCRAT)

This is the most popular method. It is one of the National Cancer Institute's (National Cancer Institute) tests. It is also called (BCRAT) . It was first introduced in 1989. It looks at the risk of developing invasive breast cancer within the next five years and up to the age of 90. It can be done in about five minutes.

The questions asked here are:

• your age.
• Your race/ethnicity.
• History of having children.
• Previous breast biopsy tests.
• Age at onset of menstruation.
• Family history of breast cancer.

If your five-year risk is 1.67% or higher, you are considered "high risk." Your doctor may prescribe medications like tamoxifen and raloxifene to help reduce your risk of cancer. But this method doesn't work for everyone. If you have had breast cancer before, or if you know you have a genetic mutation that increases your risk, this method isn't as reliable.

2. IBIS model (IBIS - Tyrer-Cuzik model)

This method looks at the likelihood of developing cancer within the next 10 years or over a lifetime.

Things you hear in this:

• Age, race/ethnicity.
• Breast density.
• History of having children.
• Body Mass Index (BMI).
• Previous breast biopsy tests.
• History of ovarian cancer.
• Family history of breast cancer.
• The age at which menstruation began and stopped.
• Use of hormone replacement therapy (HRT).
• Knowledge of whether there is a `(BRCA1)` or `(BRCA2)` gene mutation.

Like the Gale model, this does not work for people who have had breast cancer before. Based on these results, your doctor can decide how often you should have breast screenings or whether you should have BRCA genetic testing.

3. BCSC Risk Calculator (Breast Cancer Surveillance Consortium's Risk Calculator)

This looks at the risk of developing invasive breast cancer within the next five years or metastatic breast cancer within the next six years. `Metastatic` cancer is cancer that starts in the breast and spreads to other parts of the body.

The questions asked here are similar to the previous ones. Age, race, breast density, number of children, BMI, previous biopsy results, cancer history (personal and family), age at menopause, use of HRT, etc. These results can help you decide how often you should have mammograms.

4. BRCAPRO

This method mainly looks at the likelihood that you have a `(BRCA1)` or `(BRCA2)` gene mutation.

This will ask questions about your family history of breast or ovarian cancer. This means:

• Their age when cancer was diagnosed.
• Their current age (or age at death).
• Race/ethnicity (especially Ashkenazi Jewish descent).
• Cancer-related genetic test results (like `(BRCA1, BRCA2)`).
• Whether you have had cancer-related surgeries (`(mastectomy)` - breast removal, `(oophorectomy)` - ovary removal).

These results can tell you whether it's a good idea for you to get a genetic test.

5. BOADICEA (CanRisk tool)

This, like BRCAPRO, is based on family history and genetic information. It looks at the risk of breast cancer as well as ovarian cancer. There is an online tool called CanRisk. It also asks about age, BMI, breast density, childbearing, birth control pill use, age at menarche, family cancer history, and knowledge of genetic mutations. This also helps determine whether genetic testing is necessary and what the testing schedule should be.

6. BWHS Breast Cancer Risk Calculator (Black Women's Health Study Breast Cancer Risk Calculator)

This is specifically designed for black women, because race and ethnicity are important factors in determining breast cancer risk. It's important to consider how your race/ethnicity affects your risk score when figuring out your risk. As mentioned earlier, this also asks about things like age, BMI, fertility, biopsy history, birth control pills, age at menarche, family history, and whether you've had your ovaries removed.

How does the doctor use these results?

It's normal to feel scared and anxious if you take an online assessment like this and see that you're "high risk." But don't make decisions based on those results. This is something you should discuss with your doctor. These results will help your doctor plan how to monitor your breast health, identify symptoms early, and begin treatment.

Depending on the results, your doctor may do the following:

• You may be asked to have breast cancer screenings (e.g., mammograms) earlier and more frequently than usual.
• Genetic counseling can help you find out if you have a genetic mutation that increases your risk of cancer. If you already know you have one, it can help you understand how it could affect your health and your family (for example, the chance that a child will inherit the gene).
• Medications such as tamoxifen and raloxifene can be prescribed to reduce the risk of breast cancer.
• If the risk is very high, a prophylactic mastectomy (removal of the breast before cancer develops) may be recommended. This can significantly reduce the risk of developing cancer.

How reliable are these risk assessments?

The reliability of these assessment methods depends on the data sets used to create them. These methods collect information from people who have developed cancer and compare their risk factors with the risk factors of the person doing the assessment. However, population data cannot be 100% accurate in predicting anyone's personal health. No matter how many risk factors are similar, no two people are ever exactly the same.

Here are some of the limitations:

• Differences in data by race/ethnicity: Depending on the population data used to create an estimate, the results may not be as relevant to you. For example, breast cancer data has historically been collected more from non-Hispanic whites. Although data is now collected for other races, not all estimates take these differences into account in the same way.
• Applicability to limited types of cancer: Most tests look at the risk of aggressive and widespread cancer in people who have not yet developed cancer. They do not tell the story of people who have already developed cancer.
• Incomplete risk factors: No single screening method takes into account all the risk factors for all types of breast cancer. Most current screening methods focus on either genetic risk factors or risk factors related to your health history. So your doctor may recommend that you have several screening methods to get a more complete picture.

However, these breast cancer risk assessment methods are still used by doctors because they are good enough to give a rough estimate of a person's risk. Researchers are looking for ways to further improve their effectiveness.

Finally, things to remember

Okay, so I hope you've gotten some ideas from what we've talked about.

A breast cancer risk assessment cannot tell you for sure whether you will develop cancer. However, it can help your doctor understand what factors may increase your risk.

Breast cancer screening is important for everyone. A risk assessment is just one additional tool that a doctor can use to monitor your breast health. This assessment may refer you to a genetic test for the BRCA gene. You may need to have more frequent tests. Ultimately, all of this helps your doctor catch cancer at an early stage, when it can be cured. So don't be afraid to talk to your doctor about it, and take the necessary steps.

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