02 Oct Breast Cancer: High Risk-Gail Model

I was presenting at a conference today to help kick off Breast Cancer Awareness Month. I happened to give a generalized overview on what Breast Cancer is, how it starts, risk factors, prevention, and the importance of screening. When it was opened for questions, one of the big questions that came up was something called the Gail Model. Due to the questions surrounding the Gail Model, I figured it would be a good topic for today.
Vital Statistics to keep in mind:

• 1 in 2 men will develop a cancer in their life time.
• 1 in 3 women will develop a cancer in their lifetime.
• The lifetime risk for any woman being diagnosed with Breast Cancer is 1 in 8.
• Of all Breast Cancers diagnosed in the U.S., there is only a 5 to 10% chance that it is related to genetics and family history of Breast Cancer.
• There are about 10 million women in the U.S. today that would be categorized as High-Risk.

The Gail model was developed in order to help give physicians a tool to help screen all women for their life-time breast cancer risk. Being able to identify women with an increased risk for Breast Cancer, especially in a defined time interval, is a key step in the reduction of Breast Cancer. Numerous risk factors in Breast Cancer have been identified, but the interactions between these risk factors is very complex. This is where the Gail Model comes into play.
So what is the Gail Model?
The Gail Model is mathematical modeled equation that takes into account several different risk factors for breast cancer, and then calculates and predicts the 5 year and Lifetime rates of both invasive and non-invasive Breast Cancer. The factors that the model takes into consideration are:

1. Does the patient have a history of DCIS, LCIS or any breast cancer?
2. What is the woman’s age?
3. What was the age of the woman’s first menstraul period?
4. What was the woman’s age of her first live birth of a child?
5. How many of the woman’s first degree relatives (mother, sister, daughter) have had Breast Cancer?
6. Has the women ever had a Breast biopsy? (How many biopsies, have they had any atypical hyperplasia?)
7. What is the woman’s race/ethnicity?

The model is based on risk factor data prospectively collected during the Breast Cancer Detection and Demonstration Project. This study was conducted in the 1970’s. It involved 270,000 women in the U.S. that were screened for Breast Cancer and the follow up data that was collected on these patients for several years following.
The original Gail Model was limited since it was really only meant to assess the risk of Caucasian women that had regular mammograms performed. The Gail Model was then modified to be used in the first Breast Cancer Prevention Trial bu statisticians from the National Surgical Adjuvant Breast and Bowel Project (NSABP). This new and improved modified model uses composite age-specific rates for invasive Breast Cancer in both Caucasian and African American Women that were derived from the SEER data. Modifications were then again made for the STAR trial which compares the effects of Tamoxifen and Reloxifen on High-Risk Patients, so SEER data that took into account rates on Hispanic women were incorporated as well.
Women that end up having a High-Risk for Breast Cancer should then be monitored closely. Routine mammography is the biggest component to preventive care for these patients. The next thing is that in women that are post-menopausal, Tamoxifen or Raloxifen should be offered as well. The Star Trial has shown that in post menopausal women receiving either Tamoxifen or Raloxifen for 5 years, that they have a 50% reduction in their Breast Cancer risk.
What does this all mean?
What this means is that there is a potential for us to save close to 5 million lives just by offering Tamoxifen or Raloxifene to those women that are shown to have a High-Risk with the Gail Model. There is no reason that every woman ages 35-60 can not be easily screened and their data entered into the Gail Model. This way it will help women to know if they are at High-Risk for Breast Cancer, and if so, take the proper actions to screen themselves and to ensure detection at an early stage.
If you would like to take the Test yourself, you can find it here: GAIL MODEL This model is directly from the National Cancer Institute (NCI) and is trusted to be the most reliable source for all medical professionals and the general public.
As always, if you or a loved one have any other questions or concerns, or need any more information on any other cancer related topics, please feel free to contact me at: CANCERGEEK@GMAIL.COM
~CancerGeek