What is a breast cancer risk assessment test?

Many women may know the importance of breast cancer screenings, as treatment success rates are higher if breast cancer is caught early. Some may already be familiar with various types of breast cancer screenings, such as a breast exam, mammogram, ultrasound or MRI.

However, women may not be as familiar with a breast cancer risk assessment. “It’s a tool that can help women, and doctors predict a woman’s likelihood of getting breast cancer over her lifetime,” says Dr. Lori Uyeno, a Sharp Community Medical Group breast surgeon affiliated with Sharp Memorial Hospital and Sharp Mary Birch Hospital for Women & Newborns.

Many breast cancer risk tools can estimate a woman’s lifetime risk of developing breast cancer. Each varies slightly on the risk factors included in the risk score, and the patient population used to develop the risk model.

A breast cancer risk assessment calculates a score based on the person’s risk factors, such as:

• Age – Women who are older are at greater risk for breast cancer.

• Breast density – Women with denser breast tissue have a greater chance of developing breast cancer.

• Genetic mutations – Women who have genetic mutations, such as BRCA1 and BRCA2, are at higher risk of developing breast cancer.

• Menstruation history – Women who start their menstrual periods before age 12 and who start menopause after age 55 are at increased risk of developing breast cancer due to more prolonged exposure to hormones.

• Childbirth history – Women who have their first pregnancy after turning 30, have not breastfed, and have never had a full-term pregnancy have a higher breast cancer risk.

The benefit of the BCRAT

The U.S. National Cancer Institute’s Breast Cancer Risk Assessment Tool (BCRAT) is a common breast cancer risk assessment. It’s also called the Gail model, named after Dr. Mitchell Gail, who created it.

The BCRAT considers the following breast cancer risk factors for women:

• Age

• Race/ethnicity

• Family history of breast cancer

• Age when a woman got her period for the first time

• Age when a woman gave birth to her first child

• Previous breast biopsies

“This assessment, which can be discussed with a doctor, can be helpful for identifying some women’s potential risk,” says Dr. Uyeno.

However, Dr. Uyeno adds that women should keep in mind that this assessment is simply a tool to help doctors understand their patients’ risks. This, in turn, can aid in the development of a breast screening plan for women who are at higher risk.

“Although the assessment can provide a woman and her care team with a general idea, sometimes it can overestimate or underestimate risk,” she says.

Who cannot use the BCRAT

Additionally, the BCRAT model has some additional limitations. The assessment is designed for women, not men. It cannot accurately calculate risk for women of certain ethnic backgrounds, such as Black, Hispanic and American Indian/Alaskan Native women. In these groups of women, a different risk calculator may be selected to estimate risk more accurately.

The BCRAT also should not be used for the following:

• Women who have the gene mutation BRCA1 or BRCA2

• Women who previously had invasive or in situ breast cancer (lobular carcinoma in situ or ductal carcinoma in situ)

After skin cancers, breast cancer is the most diagnosed type of cancer among women in the United States. Breast cancer is also the second deadliest cancer among women in the U.S. after lung cancer, leading Dr. Uyeno to stress that preventative efforts and early detection are critical when it comes to breast cancer.

“I encourage women to educate themselves, use available tools, and collaborate with their doctor for determining their breast cancer risk and working towards their well-being,” she says.

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