Five-year and lifetime risk of breast cancer among U.S. subpopulations: implications for magnetic resonance imaging screening.

Abstract

Guidelines from the American Cancer Society recommend annual breast magnetic resonance imaging (MRI) screening for women with a projected lifetime risk of ≥20% based on risk models that use family history. Because MRI screening is costly and has limited specificity, estimates of the numbers of U.S. women with ≥20% breast cancer risk would be useful. We used data from the 2000 and 2005 National Health Interview Survey and the National Cancer Institute (NCI) Breast Cancer Risk Assessment Tool (i.e., Gail model 2 with a revision for African Americans) to calculate estimates of U.S. women by age and race/ethnicity categories with a lifetime absolute breast cancer risk of ≥20%. Distributions of 5-year and lifetime absolute risk of breast cancer were compared across demographic groups. We estimated that 1.09% (95% confidence interval, 0.95-1.24%) of women age 30 to 84 years have a lifetime absolute breast cancer risk of ≥20%, which translates to 880,063 U.S. women eligible for MRI screening. The 5-year risks are highest for white non-Hispanics and lowest for Hispanics. The lifetime risks decrease with age and are generally highest for white non-Hispanics, lower for African American non-Hispanic, and lowest for Hispanics. We provide national estimates of the number of U.S. women who would be eligible for MRI breast screening and distributions of 5-year and lifetime risks of breast cancer using the NCI Breast Cancer Risk Assessment Tool. These estimates inform the potential resources and public health demand for MRI screening and chemopreventive interventions that might be required for U.S. women.