Breast Cancer Risk Assessment: What Every Woman Should Know

When actress Olivia Munn announced last week that a breast cancer risk assessment tool saved her life, many women wondered why they’d never heard of the test. The result placed Ms. Munn in the high-risk category and sent the 43-year-old for an MRI that revealed she had an aggressive cancer in both breasts. She underwent a double mastectomy in 2023.

While it’s important to know your risk, rushing to complete an online risk assessment such as the GAIL or BCRAT model, or the Tyrer-Cuzick Risk Assessment Calculator yourself, is not recommended, warn the experts at Miami Cancer Institute, part of Baptist Health.

“These risk assessment tools ― and there are several of them ― are used for different purposes and we determine which tool to use based on many factors,” said Ana Sandoval Leon, M.D., a Miami Cancer Institute medical oncologist who oversees the Institute’s Breast Cancer Prevention Clinic, which sees women and men at risk. On your own, it can also be difficult to interpret the results.

“It’s always good when someone famous puts themselves out there because it helps to build awareness,” said Arelis Mártir-Negrόn, M.D., director of the Division of Clinical Genetics at the Institute. “At the same time, there is a lot of misinformation. It can cause a lot of distress. We really recommend that women talk to their doctors about performing a risk assessment.” In addition to helping determine if a patient qualifies for a high-risk cancer screening, the tools can also calculate whether they fit the criteria for preventive medications.

Breast Cancer Risk Factors

Breast cancer is the most common cancer and the second leading cause of death in women in the U.S. About one in eight women will develop breast cancer in her lifetime and more than 310,000 cases will be diagnosed in 2024, according to the American Cancer Society. In general, the earlier breast cancer is caught, the better the chance for a cure.

The various assessment tools calculate risk based on factors that include, but are not limited to:

• Age
• Age at first menstruation
• Age at the time of birth of a first child
• Family history of breast cancer
• Number of breast biopsies
• A biopsy that shows atypical hyperplasia, which are accumulations of abnormal cells in the breast
• Race/ethnicity
• Weight
• Breast density

In all likelihood, your ob/gyn or primary care physician has asked you these questions in the past. But if you don’t recall, inquire, the doctors say. They also stress that the assessments have limitations, and while they can estimate your risk, they cannot predict whether or not you will develop breast cancer.

Genetics and Family History

“The results need to be interpreted by a healthcare professional,” Dr. Mártir-Negrόn says. “If anything, the assessments can overestimate risk, and we don’t want women having unnecessary MRIs or biopsies. But the assessments are very important.”

Dr. Mártir-Negrόn, who has been performing risk assessments for 15 years, says that while all factors need to be explored, the most significant is family history.

Most women know that mutations in the BRCA1 and BRCA2 genes raise the breast cancer risk in Ashkenazi Jewish women, as well as Blacks and Hispanics. But with the rapid evolution of genetics, doctors now know of many other gene mutations that up the chances of breast cancer, including ATM, BARD1, CHEK2, RAD51C, RAD51D, PALB2, CDH1, TP53, STK11 and NF1.

Any woman can inherit a mutation from her parents, which is why it’s especially important to know your family history from both your mother and father, the doctors explain. At the same time, while up to 15 percent of cancers are tied to a hereditary link, not everyone with a genetic mutation will go on to develop cancer.

Most medical organizations recommend that a woman begin assessment at age 25.

If Your Risk Is High …

Ms. Munn indicated that genetic testing revealed no known mutations linked to breast cancer and her annual mammogram did not show any abnormalities. Without knowing more about Ms. Munn’s circumstances, the doctors speculate that her mammogram did not pick up signs of cancer either because her breasts are very dense or the cancer was extremely small – or a combination of the two.

A family history of cancer alone ― whether it’s early-onset breast cancer, ovarian cancer, a family member with more than one type of cancer or a family history of pancreatic cancer, among others ― should prompt discussion with a healthcare professional about genetic testing and counseling. In Ms. Munn’s case, it’s possible that she has multiple relatives who have had breast cancer, including early onset, and that may be why doctors recommended an MRI.

“A lifetime risk of 20 percent or more places a woman at high risk,” Dr. Sandoval says. “These are women we would like to see to determine the need for genetic testing and counseling or additional imaging studies.”

For some women at high risk, both an annual MRI and an annual mammogram are recommended. In addition, clinical examination is always part of the regular follow-up, and individualized breast health plans and lifestyle modification recommendations regarding exercise, diet and lifestyle changes are developed.

If you have questions about your risk, talk to your healthcare provider. Or if you have known risk factors, see a specialist at the Breast Cancer Prevention Clinic or the Division of Clinical Genetics.