By Emma Simpson, MD, Chair of Radiology
EPIC’s EMR adopted by MLH provides an automatic generation of risk assessment for breast cancer using the modified Gail Risk model. This risk assessment had been calculated and included in some MLH screening mammograms in the past, but with the adoption of EPIC, this piece of data is included in more of the reports and is commonly in the EPIC record. It is based on an original algorithm derived from a screening database of 280,000 US women ages 35-74 and then subsequently modified to improve the accuracy in women with a previous biopsy.
What are the factors considered in calculating the modified Gail Risk Score?
Personal medical history, reproductive history, first degree relatives with breast cancer, and the number of and results of previous breast biopsies.
Is it accurate for all women?
The main caveat to using the Gail Risk Score is possible underestimation of risk. While MLHS has implemented the score for women aged 35-74 it is important for all providers to consider the factors that could limit its accuracy. It is not applicable for women with a history of invasive breast cancer, DCIS or LCIS. It was validated in a population of Caucasian women living in the United States, and therefore may have limited applicability to those with other racial or ethnic backgrounds. There are other factors that increase risk for breast cancer that are not considered in this model.
How do I use the risk score?
It is important to keep in mind the limitations of the score, some of which are listed above and mostly can result in underestimation. A normal or low score does not mean a patient won’t get breast cancer. Average lifetime risk is 12% in the US. The literature shows that patients with a lifetime risk score of 20% or higher benefit by having a screening MRI and most insurers will cover the study for these high risk patients if their mammogram also show dense or heterogeneously dense breasts. We also recommend considering referring women with a life time risk score of 20% or higher to a breast surgeon and a genetic counselor who can determine if genetic testing is appropriate. Patients with known genetic mutations such as BRCA1 or BRCA2 as well as other hereditary syndromes benefit from similar referrals, regardless of the Gail Risk score.
Are there better risk tools available?
MLH is exploring other, newer risk model tools through the system Breast Tumor Work Group. We will keep you posted. Please feel free to call one of our breast centers and speak with one of our breast imagers if you have questions. You can reach the MLH Cancer Risk Assessment and Genetics at 484-565-GENE. The phone numbers for the Nurse Navigators at each breast center are listed below.