What the breast cancer risk assessment tool can and cannot tell you

 The Breast Cancer Risk Assessment Tool (BCRAT) can estimate a female’s risk of developing breast cancer in their lifetime, but it cannot tell who will get breast cancer or not.

The BCRAT is a short questionnaire that calculates a female’s lifetime risk of developing invasive breast cancer. People may also refer to the BCRAT as the Gail model.

This article discusses the BCRAT in more detail, including its accuracy, risk factors for breast cancer, and how a person can help reduce their risk.

What can the BCRAT do?

The BCRAT uses certain information about a person’s medical history, reproductive history, and family history of breast cancer to estimate the riskTrusted Source of developing invasive breast cancer.

Healthcare professionals can use the BCRAT to estimate the risk of a female developing invasive breast cancer in the next 5 years through to the age of 90 years. This is called the lifetime risk.

The BCRAT can estimate absolute breast cancer risk. “Absolute risk” is the risk of developing breast cancer across a certain time period.

What personal information does it use?

The BCRAT requires the followingTrusted Source personal information:

• breast cancer history
• history of chest radiation therapy for Hodgkin’s lymphoma
• genetic mutation of the BRCA1 or BRCA2 gene, or a diagnosis of genetic risk factors for breast cancer
• age (between 35 and 85 years)
• race and ethnicity, and in some cases, place of birth or subrace or ethnicity
• medical history of breast biopsy with benign diagnosis or atypical hyperplasia
• age of first menstrual period
• if a person has given birth, the age they gave birth to their first child
• number of first-degree relatives who have had breast cancer

The calculator uses the answers to these questions to estimate a person’s risk for breast cancer.

Breast cancer risk factors

There are risk factorsTrusted Source for breast cancer that people cannot change, such as genetics, and other risk factors that people can help manage, such as lifestyle factors.

Nonmodifiable risk factors

Breast cancer risk factors that people cannot control include:

• age, as breast cancer risk increases with older age
• certain inherited genetic mutations
• starting menstrual periods younger than 12 years old
• starting menopause after the age of 55
• dense breasts, which can increase the risk of breast cancer and can make diagnosis more difficult
• history of breast cancer or some types of noncancerous breast disease
• family history of breast cancer or ovarian cancer
• radiation therapy to the chest before the age of 30
• exposure to diethylstilbestrol (DES), a drug that people may have had during pregnancy between 1940 and 1971 in the United States

Modifiable risk factors

Is the BCRAT accurate?

According to the National Cancer InstituteTrusted Source, the BCRAT may be accurate for estimating risk, but this does not always predict who will or will not develop breast cancer. Some people with high risk factors will not develop breast cancer, while others with a lower risk may.

A 2018 systematic reviewTrusted Source found the BCRAT more accurate for predicting breast cancer in American and European females. The tool may overestimate the risk by around twice as much in Asian females.

Breast cancer risk factors that people can change include:

• reduced physical activity
• having overweight or obesity after menopause
• taking some birth control pills
• taking hormone replacement therapy containing both estrogen and progesterone during menopause for more than 5 years
• having a first pregnancy after the age of 30
• not breastfeeding or chestfeeding, whether they have a choice to do so or not
• never having a full-term pregnancy
• drinking alcohol

Learn more about breast cancer risk factors.

What are the limitations of the BCRAT?

According to the National Cancer InstituteTrusted Source, the BCRAT has the following limitations:

• The calculator may underestimate breast cancer risk in Black females who have had previous biopsies and Hispanic females who were not born in the United States.
• There is also limited data on American Indian/Alaska Native females. For this reason, estimates may not be accurate as they are partially based on data from white females.

The calculator is not an accurate tool for estimating breast cancer risk in the following cases:

• people with a BRCA1 or BRCA2 genetic mutation
• individuals with a history of invasive breast cancer or in situ breast cancer, which includes lobular carcinoma in situ (LCIS) or ductal carcinoma in situ (DCIS)
• people with an inherited breast cancer-causing syndrome, such as Li-Fraumeni syndrome.

Other breast cancer risk assessment tools

The BCRAT is not an accurate tool for everyone. People with certain medical histories will need to useTrusted Source other risk assessment tools:

• People with a history of LCIS can use the IBIS Breast Cancer Risk Evaluation Tool.
• People with a known mutation of the BRCA1 or BRCA2 gene can use the BOADICEA model.

A person can consult a doctor to discuss their breast cancer risk. This is particularly important if they have:

• a history of DCIS
• a history of radiation therapy to the chest for Hodgkin’s lymphoma
• history of breast cancer
• an inherited breast cancer-causing syndrome

How to lower the risk of breast cancer

People may be able to reduce their riskTrusted Source of breast cancer by:

• achieving and maintaining a moderate weight
• keeping physically active with moderate to vigorous exercise
• limiting or avoiding alcohol
• eating a nutritious diet
• nursing for several months after childbirth
• taking nonhormonal methods for treating menopause symptoms

People with an increased risk of breast cancer may also consider the following:

• genetic counseling to test for breast cancer risk
• medications to reduce breast cancer risk
• preventive breast or ovarian surgery
• close monitoring, such as more frequent breast exams and earlier screening tests.

Summary

The BCRAT is a tool females can use to estimate their lifetime risk of developing invasive breast cancer.

A person answers a short questionnaire on medical and reproductive history to assess their breast cancer risk.

The BCRAT can estimate risk, but it cannot predict who will or will not develop breast cancer.

Source - Medical News Today

 

What to know about breast cancer

 Breast cancer is an invasive cancer. It most commonly occurs due to a genetic mutation or damage to DNA. Treatment may involve surgery, radiation therapy, or chemotherapy.

Breast cancer can affect females or males, but this article will focus on the condition in females. Although most breast cancers do not have symptoms, a person may feel a lump in the breast, changes to the nipple, and armpit or breast pain.

Anyone with symptoms of breast cancer should speak with a healthcare professional. Prompt diagnosis and treatment may improve a person’s outlook.

This article explains the symptoms, causes, and types of breast cancer. It also explores treatment options and outlook.

According to the American Cancer Society (ACS), the most commonTrusted Source symptom of breast cancer is a mass or a lump in the breast or an armpit.

Other symptoms may include:

• pitting or dimpling of breast tissue, like the surface of an orange
• nipple discharge
• swelling
• nipple or breast pain
• a sunken or inverted nipple
• dryness, flaking, or thickening of the breast or nipple skin
• swollen lymph nodes

The ACS highlights that most breast lumps are not cancerous. However, anyone who notices a breast lump should see a healthcare professional.

Causes of breast cancer

Breast cancer developsTrusted Source due to genetic changes that can be inherited or acquired (not inherited).

Researchers associateTrusted Source an increased risk of breast cancer with factors such as:

• estrogen exposure
• inherited genetic irregularities
• inherited genes that increase the likelihood of cancer, such as BRCA1 and BRCA2 mutations

The immune system typically attacks atypical DNA or growths, but it does not do this when a person has cancer.

As a result, cells within breast tissue multiply uncontrollably and do not die as usual. This excessive cell growth forms a tumor that deprives surrounding cells of nutrients and energy.

Types of breast cancer

After puberty, female breasts consist ofTrusted Source:

• fat
• connective tissue
• lobes, which contain tiny milk-producing glands called lobules

The most commonTrusted Source types of breast cancer are lobular carcinoma, which begins in a lobule, and ductal carcinoma, which begins in one of the tiny ducts that carry milk from the lobules to the nipples.

Invasive vs noninvasive

Invasive breast cancer involves cancerous cells spreading to nearby tissue. Cancer may then spread to other parts of the body.

In contrast, noninvasive breast cancer remains in its place of origin. Doctors may consider this a “precancerous lesion.” These cells may eventually become invasive.

Stages of breast cancer

A healthcare professional may stageTrusted Source breast cancer using something called the TNM system, which consists of five different stages. To do this, doctors examine:

• primary tumor size (T)
• regional lymph node status (N)
• distant metastasis (M)

Each category contains substages, which can indicate specific tumor characteristics, such as whether it is positive or negative for a protein called human epidermal growth factor receptor 2 (HER2).

Staging helpsTrusted Source healthcare professionals learn whether cancer has spread and determine the best treatment options. People can speak with a doctor about cancer stages and what they mean.

Breast cancer risk factors

The following factors may make developing breast cancer more likely.

Age

The risk of breast cancer increases with age.

According to a 2024 articleTrusted Source that cites older research, around 95% of new cases occur in females older than 40.

It states that breast cancer affects 1.5 in every 100,000 females ages 20 to 24, increasing to 421.3 in every 100,000 of those ages 75 to 79.

Genetics

Females who inherit certain mutations in the BRCA1 and BRCA2 genes have a higher chanceTrusted Source of developing breast cancer, ovarian cancer, or both. Mutations in the TP53 gene also have links to an increased breast cancer risk.

If a close relative experiences breast cancer, a person’s chance of developing breast cancer increases.

Testing guidelines

Current guidelines recommend people have genetic testing if their family history includes:

• breast cancer
• ovarian cancer
• fallopian tube cancer
• peritoneal cancer
• breast cancer related to BRCA gene mutations

Around 1 in 40Trusted Source females of Ashkenazi Jewish heritage have a BRCA gene mutation. This can raise their risk of breast cancer.

Experts recommend people with this heritage consider genetic testing if a first-degree relative, such as a sister, experiences breast cancer. They also recommend it if two second-degree relatives, such as a grandmother, on the same side of the family have a history of the condition.

History of breast cancer or breast lumps

A person with a previous history of breast cancer is more likelyTrusted Source to develop the condition than a person who has not had it before.

Having some types of noncancerous breast conditions, including atypical ductal hyperplasia or lobular carcinoma in situ, also increases the riskTrusted Source of developing breast cancer.

Estrogen exposure and hormone treatments

Extended exposure to estrogen and progesterone may increaseTrusted Source the risk of breast cancer. This exposure could involve starting periods early or entering menopause late.

Some researchTrusted Source associates hormone replacement therapy (HRT), specifically estrogen-progesterone therapy, with an increased risk of breast cancer.

The National Cancer Institute (NCI)Trusted Source also highlights studies suggesting that oral contraceptives may slightly increase the risk of breast cancer. However, this risk declined after stopping the use of oral contraceptives.

Race

Although some researchTrusted Source suggests breast cancer rates are highest in the non-Hispanic white population, the Centers for Disease Control and Prevention (CDC)Trusted Source states breast cancer mortality is higher among Black females than white females.

According to a 2021 studyTrusted Source, Black females may be more susceptible to developing aggressive breast tumors.

Other researchTrusted Source points out that other factors, such as socioeconomic disparities, contribute to racial differences in treatment options and cancer mortality.

For example, a 2020 studyTrusted Source suggests difficulty accessing quality health insurance may contribute to late breast cancer diagnoses among people from marginalized groups.

Even with treatment, people are less likely to have a positive outcome when doctors diagnose breast cancer at a late stage.

Other risk factors

The following factors may also increase the risk of breast cancer:

• Obesity: Obesity after menopause may contribute to a greater likelihoodTrusted Source of developing breast cancer, possibly due to increased estrogen levels.
• Regular alcohol consumption: According to the NCITrusted Source, studies consistently find that females who consume alcohol have a higher risk of breast cancer than those who do not.
• Dense breast tissue: Dense breast tissue isTrusted Source a risk factor for breast cancer.
• Radiation therapy: Undergoing mantle field irradiation treatment for a different cancer may increase the risk of developing breast cancer later in life.

Learn more about dense breast tissue.

Cosmetic implants and breast cancer survival

Some research in a 2023 systematic reviewTrusted Source associates certain rare cancers, such as lymphoma or squamous cell carcinoma, with breast implants.

However, the review highlights that experts generally consider breast augmentation to be safe. Other research had the following findings:

• A 2015 meta-analysisTrusted Source of 17 studies that included participants who had undergone cosmetic breast augmentation found no increased risk of breast cancer associated with the procedure. The incidence among these participants was lower than expected.
• Research from 2021 suggests females with cosmetic implants have significantly lower rates of breast cancer than those without.
• A 2020 studyTrusted Source into the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) in 3,546 people with macro-textured breast implants found the overall BIA-ALCL risk was higher than previous literature stated. The authors highlight the need for further evaluation.

Diagnosing breast cancer

A doctor may diagnose breast cancer during routine screening or when a person reports symptoms. The following tests and procedures can help with a diagnosis:

Breast exams

This involves checking the breasts for lumps and other possible indications of cancer.

During the examination, the person may need to sit or stand with their arms in different positions, such as above their head or by their sides.

Imaging tests

The following scans may help detect breast cancer:

• Mammogram: Doctors commonly use this type of X-ray during initial breast cancer screening. It produces images that can show lumps or irregularities.
• Ultrasound: This scan helpsTrusted Source a doctor evaluate the size and consistency of a lump. It may help differentiate between a solid mass and a fluid-filled cyst.
• MRI: This combines different images to help doctors identify cancer or other irregularities. A doctor may recommend an MRI as a follow-up to a mammogram or ultrasound.

Biopsy

A biopsy involves extracting a tissue sample and sending it to a laboratory for analysis. The results can show:

• if cells are cancerous
• the type of cancer, if present
• whether the cancer is hormone-sensitive

The doctor then stages the cancer using information such as the tumor size and how far the cancer has spread. This can provide information about the person’s outlook and the best course of treatment.

Further resources

Learn more with the following articles:

• How to check your breasts
• Preparing for a mammogram
• A breast biopsy: What to expect

Treating breast cancer

Treatment may depend on:

• the type and stage of the cancer
• the tumor’s sensitivity to hormones
• the person’s age, overall health, and preferences

Cancer treatments can have adverse side effects. Before deciding on a treatment, people can discuss the potential risks with a doctor.

Treatment options include the following:

Surgery

If surgery is necessary, the type will depend on the diagnosis and the person’s preferences. Types include:

• Lumpectomy: A lumpectomy involves removing the tumor and a small amount of healthy tissue around it. It may be an option if the tumor is small and easy to separate from surrounding tissue.
• Mastectomy: A mastectomy involves removing the breast’s lobules, ducts, fatty tissue, nipple, areola, and some skin. In some types, a surgeon also removes the lymph nodes.
• Sentinel node biopsy: This procedure involves the removal of lymph nodes to helpTrusted Source doctors see how far cancer has spread and decide the best treatment.
• Axillary lymph node dissection: If a doctor finds cancer cells in the sentinel nodes, they may recommend removing additional lymph nodes in the armpit with an axillary lymph node dissection.

Following a mastectomy, a surgeon can reconstruct the breast so that it looks more natural. This can help a person cope with the psychological effects of breast removal.

The surgeon can reconstruct the breast during the mastectomy or at a later date. They may use a breast implant or tissue from another body part.

Learn about breast reconstruction surgery.

Radiation therapy

A person may undergo radiation therapy during or after surgery. It is most common following a lumpectomy, but some people may require radiation after a mastectomy.

This therapy involves targeting the tumor with controlled doses of radiation that kill any remaining cancer cells.

Chemotherapy

A doctor may prescribe chemotherapy if there is a high risk of recurrence or spread. Chemotherapy after surgery is called adjuvant chemotherapy.

A doctor may recommend chemotherapy before surgery to shrink the tumor and make it easier to remove. This is called neoadjuvant chemotherapy.

Hormone-blocking therapy

Hormone-blocking therapy may help treat estrogen receptor-positive and progesterone receptor-positive cancers. Healthcare professionals may administerTrusted Source it after surgery to prevent recurrence or beforehand to shrink the tumor.

Hormone-blocking therapy may be an option for people who cannot have surgery, chemotherapy, or radiotherapy.

Examples of hormone-blocking medications may include:

• tamoxifen (Nolvadex)
• aromatase inhibitors
• ovarian ablation or suppression
• goserelin (Zoladex)

Biological treatment

Targeted drugs, such as trastuzumab (Herceptin) and lapatinib (Tykerb), can destroy specific types of breast cancer.

Can people prevent breast cancer?

There is no way to prevent breast cancer. However, the following steps may help reduce the risk:

• limiting alcohol consumption
• eating a balanced diet
• getting enough exercise
• maintaining a moderate weight

Preventive surgery may also be an option for people with a high breast cancer risk.

The Bezzy Breast Cancer app provides access to an online breast cancer community where users can connect with others and gain advice and support through group discussions.

Learn more about breast cancer prevention.

Breast cancer screening

Multiple different guidelines for screening exist. The following are some recommendations for females with an average risk of breast cancer:

Organization	Guidelines
United States Preventive Services Task Force, 2024	• Ages 40 to 74: Have screenings every 2 years.
ACSTrusted Source, 2023	• Ages 40 to 45: Have screenings every year if they wish. • Ages 45 to 54: Have screenings every year. • Ages 55 years and older: Have screenings every year or 2 years.
American College of Physicians, 2019	• Ages 40 to 49 years: Discuss the benefits and risks of regular screenings with a doctor. • Ages 50 to 74: Have screenings every 2 years. • Ages 75 or older: Continue with screenings if they have a life expectancy of 10 or more years.

Despite the slight variations, most experts recommend at least speaking with a doctor about breast cancer screening from the age of 40 onward.

People can speak with their doctor about breast screening guidelines and create a screening plan that works for their circumstances.

Breast cancer survival rates

According to a 2019 article, breast cancer death rates declined by around 40%Trusted Source between 1989 and 2017. However, a 2019 study suggested the rate in the United States may no longer be declining among females ages 20 to 39 years.

A survival rate describes how long a person with breast cancer is likely to live after diagnosis compared with someone who does not have the condition.

The NCI currently estimates that about 91%Trusted Source of females with breast cancer will survive for at least five years after diagnosis.

It is important to remember that researchers use survival rates to assess large populations. In calculating this rate, they exclude the risk of dying from other causes.

A survival rate cannot predict a specific individual’s outlook.

Frequently asked questions

Is breast cancer painful?

A lump or a mass in the breast is the most commonTrusted Source symptom of breast cancer. These lumps are usually painless. However, a person may experience pain in the nipple or breast area that appears connected to their menstrual cycle.

Anyone who experiences breast pain, especially if it is severe or persistent, should consult a healthcare professional.

How long can someone have breast cancer without knowing?

How long a person has breast cancer without knowing may depend on the type of breast cancer, their symptoms, and screenings.

For example, inflammatory breast cancer is a rare, aggressive type of breast cancer that does not usuallyTrusted Source cause a lump and may not show on a mammogram. Diagnosis may only occur when symptoms appear during advanced stages.

What is the life expectancy for someone with breast cancer?

According to research, around 91%Trusted Source of females with breast cancer will survive for at least five years following a diagnosis. However, the ACSTrusted Source suggests the outlook for a person who receives a diagnosis now may be better than this due to old data and constant improvements in treatment.

Summary

Breast cancer may cause symptoms such as a lump, pain, or skin changes to the breast or nipple. Anyone with a breast lump should see a healthcare professional.

Treatment options may include chemotherapy, radiation, or surgery. The most appropriate treatment may depend on the cancer type and stage.

A person can take steps to reduce their risk of breast cancer, such as maintaining a healthy lifestyle and speaking with their doctor about the best pace of screening.

Source - Medical News Today