How to calculate the real risk

There is no doubt that a complete screening of breast cancer should include, in addition to clinical examination, the ultrasound and mammography, a determination of individual risk. In fact, women who are identified as exposed to high risk, must be submitted to an individualized plan of surveillance as well as a series of preventive measures, if necessary, also defined by risk.

It 'so obvious that the calculation of the risk of breast cancer is not a mere curiosity, but a very important tool that can provide the patient more aware and the doctor a baseline to assess any Intensive monitoring and preventive treatments in patients at high risk. Or at least monitoring of patients at low risk.

Suffice it to think that such a scientific study, "Breast Cancer Prevention Trial (Fisher B, Costantino JP, Wickerham DL. - Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. - J. Natl Cancer Inst 1998; 90 (18) :1371-88) has shown that in healthy women, but high-risk, meaning a risk of developing breast cancer over 5 years to 1.7%, preventive therapy with tamoxifen, after a period of 4 years, 49% reduces the incidence of breast cancer .. In any case, can be very useful tips on simple lifestyle that significantly reduce the real risk of getting breast cancer.

The calculator Risk of breast cancer offers the choice between two methods of calculation: the Gail model and the model of the NSABP. The first, named after Dr. Mitchell H. Gail, along with other colleagues he has published several popular articles describing the scientific basis for the calculation of risk. The second calculation model was developed by the NSABP, an acronym for the National Surgical Adjuvant Breast and Bowel Project. The NSABP is a great organization that has conducted many important research studies. The NSABP is playing from the original model of Gail and modified it for research purposes.

Equally well known is the risk calculator at the National Cancer Institute: it has more decimal places of accuracy, but requires only 6 questions:


*        The Breast Cancer Risk Assessment Tool was designed for use by health professionals. If you are not a health professional, you are encouraged to discuss the results and your personal risk of breast cancer with your doctor.

*        The tool should not be used to calculate breast cancer risk for women who have already had a diagnosis of breast cancer, lobular carcinoma in situ (LCIS), or ductal carcinoma in situ (DCIS).

*        The BCRA risk calculator may be updated periodically as new data or research becomes available.

*        Although the tool has been used with success in clinics for women with strong family histories of breast cancer, more specific methods of estimating risk are appropriate for women known to have breast cancer-producing mutations in the BRCA1 or BRCA2 genes.

*        Other factors may also affect risk and are not accounted for by the tool. These factors include previous radiation therapy to the chest for the treatment of Hodgkin lymphoma or recent migration from a region with low breast cancer rates, such as rural China. The tool's risk calculations assume that a woman is screened for breast cancer as in the general U.S. population. A woman who does not have mammograms will have somewhat lower chances of a diagnosis of breast cancer.

*        For information to help your patients understand cancer risk visit This interactive Web site will help your patients make informed decisions about how to lower their risk.

The computer used by us using the Gail model, and is a slightly less perfect emulation of the risk calculator for breast cancer at the National Cancer Institute, however, adds additional risk factors and therefore it is more complete. Although this calculation is based on methods and statistics to calculate the risk of breast cancer published in scientific journals skilled, specific methods used were not controvalidati. Therefore, these data can be used only as a guideline for the monitoring program. The final results are estimates of a LOW, MEDIUM or HIGH risk of getting breast cancer very useful for the planning of surveillance in relation to the age of the patient.

Major risk factors and their relative risk

Age > 50 anni 6,5
A family history 1st degree relative < 50 years 2,0
  2 first degree relatives 5,0
Anamnesis Prevous breast irradiation <15 years 20,0
  Hyperplasia 2,0
* Atypical 3,5
  Mammographic Density 4,0
  DCIS >4
History Hormone Menarche < 11 years 3,0
  Menopause > 54 years 2,0
  nulliparity 1,99
  oral contraceptives 1,4
  HRT 1,4
Diet Hight fat diet 1,2
  Obesity in post menopausal 1,2
  Alcohol consumtion 1,3

* If you are familiar with atypia are associated with conditions of synergy and the relative risk is doubled (RR = 9).

** fibrodenoma not increase the risk, except for those so-called "complex" (containing cysts, sclerosing adenosis, epithelial calcifications, or alteration of apocrine and papillary type) having a RR = 3. The radial scar RR = 2 and if hyperplasia is associated with RR = 3:

Note: If within ten years after the biopsy revealed hyperplasia with atypia does not manifest itself on a cancer risk is halved.