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Genetics of Breast and Ovarian Cancer (PDQ®): Genetics - Health Professional Information [NCI] - Introduction

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Models for Prediction of Breast Cancer Risk

Models to predict an individual's lifetime risk of developing breast cancer are available.[81,82] In addition, models exist to predict an individual's likelihood of having a BRCA1 or BRCA2 mutation. (Refer to the Models for prediction of the likelihood of a BRCA1 or BRCA2 mutation section of this summary for more information about these models.) Not all models can be appropriately applied for all patients. Each model is appropriate only when the patient's characteristics and family history are similar to the study population on which the model was based. Different models may provide widely varying risk estimates for the same clinical scenario, and the validation of these estimates has not been performed for many models.[82,83] Table 1 summarizes the salient aspects of two of the common risk assessment models and is designed to aid in choosing the model that best applies to a particular individual.

The Claus model [84,85] and the Gail model [86] are widely used in research studies and clinical counseling. Both have limitations, and the risk estimates derived from the two models may differ for an individual patient. Several other models, which include more detailed family history information, are also in use and are discussed below.

Table 1. Characteristics of the Gail and Claus Modelsa

Gail Model (Breast Cancer Risk Assessment Tool)bClaus Model
FDR = First-degree relative; SDR = second-degree relative.
a Adapted from Domchek et al.,[87]Rubenstein et al.,[88]and Rhodes.[89]
b Modified based on periodic updates.[90,91]
Data derived fromBreast Cancer Detection Demonstration Project StudyCancer and Steroid Hormone Study
Study population2,852 cases, aged ≥35 y4,730 cases, aged 20–54 y
In situ and invasive cancerInvasive cancer
3,146 controls4,688 controls
CaucasianCaucasian
Annual breast screeningNot routinely screened
Family history characteristicsFDRs with breast cancerFDRs or SDRs with breast cancer
Age of onset in relatives
Other characteristicsCurrent ageCurrent age
Age at menarche
Age at first live birth
Number of breast biopsies
Atypical hyperplasia in breast biopsy
Race (included in the most current version of the Gail model)
StrengthsIncorporates:Incorporates:
Risk factors other than family historyPaternal and maternal history
Age at onset of breast cancer
Family history of ovarian cancer
LimitationsUnderestimates risk in hereditary familiesMay underestimate risk in hereditary families
Number of breast biopsies without atypical hyperplasia may cause inflated risk estimatesMay not be applicable to all combinations of affected relatives
Does not include risk factors other than family history
Does not incorporate: 
Paternal family history of breast cancer or any family history of ovarian cancer
Age at onset of breast cancer in relatives
All known risk factors for breast cancer[89]
Best applicationFor individuals with no family history of breast cancer or one FDR with breast cancer, aged ≥50 yFor individuals with no more than two FDRs or SDRs with breast cancer
For determining eligibility for chemoprevention studies
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