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Understand Risk Assessment

 

A breast cancer risk assessment tool can aid in determining if a patient is at increased risk of breast cancer. It can help the health care provider and patient decide when the patient should begin breast cancer screening and how often. A breast cancer risk assessment considers factors such as a patient’s personal medical and reproductive history, history of breast cancer among first-degree relatives (mother, sisters, daughters), breast density, and other factors.

What is the Tyrer-Cuzick risk model and how is it used for breast cancer risk assessment?

The Tyrer-Cuzick model, sometimes referred to as the IBIS tool, provides a risk score that estimates the likelihood of a woman developing breast cancer over the course of her lifetime . The risk score is calculated using a variety of risk factors that include personal health history, as well as family health history. The score is typically expressed as a percentage.

 

The major risk factors that determine a Tyrer-Cusick risk score are:

  • Age
  • Height
  • Weight
  • Age at first period
  • Age at first child birth
  • Menopause stage
  • Age at menopause
  • History of hormone use
  • Personal BRCA genetic test results (BRCA1 & BRCA 2)
  • Personal history of atypical breast biopsies (i.e. ADH, ALH, LCIS)
  • Personal history of ovarian cancer
  • Breast tissue density
  • Ashkenazi Jewish inheritance
  • Number of sisters
  • Number of daughters
  • Number of half sisters
  • Number of aunts
  • Family history of breast cancer
  • Age at which family history of breast cancer was diagnosed
  • Family history of breast cancer diagnosed in one breast or both breasts
  • Family history of ovarian cancer
  • Age at which family history of ovarian cancer was diagnosed
  • Family history of BRCA genetic test results

What you should know

Answers to frequently asked questions

Breast cancer research and advances in risk assessment have shown that having dense breasts is a contributing factor in determining a woman’s risk of breast cancer. Dense breast tissue refers to the appearance of breast tissue on a mammogram and the makeup of supportive and fatty tissue in the breast. The more fatty tissue, the less dense the breast is. Dense breasts are common and can be caused by simply being younger, having a lower body mass index, or taking hormone therapy for menopause; researchers are still studying why some women have dense breasts and others do not.

Non-dense breast tissue appears dark and transparent, whereas dense breast tissue appears as a solid white area on a mammogram; this solid white area can make it hard for radiologists to accurately analyze the image with a mammogram alone. Therefore, your healthcare provider may recommend supplemental imaging, like a breast ultrasound or breast MRI, to increase the likelihood of finding cancer. Having dense breast tissue alone is not a cause for concern. You should speak with your healthcare provider about your breast tissue density and how it affects your risk status.

Risk assessment can help breast centers tailor screening and follow up recommendations to ensure you are receiving the care you need. Risk assessment identifies women who are candidates for additional imaging, genetic counseling, genetic testing, and/or other specialized recommendations.

Some facilities may have different guidelines, so you should check with your healthcare provider, but generally:

  • Less than 15% is considered average risk
  • Between 15-19% is considered intermediate risk
  • 20% or greater is considered high risk

Yes, there are other risk models such as Gail/NCI, BRCAPRO, Claus, BCSC and more; however, Tyrer-Cuzick has been widely accepted as the most comprehensive risk model due to more detailed data collection. Your healthcare provider may use one or more of the models listed above together.

Try an online risk assessment calculator such as:

https://ibis.ikonopedia.com/

https://magview.com/ibis-risk-calculator/

While risk calculators and other tools exist online, it is best to speak with your healthcare provider about having your risk score calculated. Learning you are high risk from an online calculator without guidance from your healthcare provider may cause unnecessary anxiety.

No, being high risk just means that when statistically compared to other women, your chances are higher, sometimes only slightly higher. It is completely understandable to be concerned about your high risk status, but early detection is your best tool against breast cancer. By identifying your risk, your healthcare providers can provide you with a personalized screening plan and/or risk reduction options.

You should speak with your healthcare provider about your specific circumstances to determine if there is anything you can do to lower your risk. In some cases, your healthcare provider may recommend lifestyle changes, and in higher risk cases, there are risk-reducing drugs and interventional surgery options. It is important, however, that your healthcare provider makes the appropriate recommendations.

No, the Tyrer-Cuzick risk model does not apply to those already diagnosed with breast cancer and those over the age of 85.

While your healthcare provider and imaging providers are the best resources, here are sites that can provide you with more information until you speak with your healthcare provider: