Performance of the Gail and Tyrer-Cuzick breast cancer risk assessment models in women screened in a primary care setting with the FHS-7 questionnaire.

Fernanda Sales Luiz Vianna,Maira Caleffi,Suzi Alves Camey,Juliana Giacomazzi,Patricia Ashton-Prolla,Luciana Neves Nunes,Cristina Brinckmann Oliveira Netto

doi:10.1590/1678-4685-gmb-2018-0110

Abstract

Breast cancer (BC) risk assessment models base their estimations on different aspects of a woman’s personal and familial history. The Gail and Tyrer–Cuzick models are the most commonly used, and BC risks assigned by them vary considerably especially concerning familial history. In this study, our aim was to compare the Gail and Tyrer-Cuzick models after initial screening for familial history of cancer in primary care using the FHS-7 questionnaire. We compared 846 unrelated women with at least one positive answer to any of the seven FHS-7 questions (positive group) and 892 unrelated women that answered negatively (negative group). Concordance between BC risk estimates was compared by Bland-Altman graphics. Mean BC risk estimates were higher using the Tyrer-Cuzick Model in women from the positive group, while women from the negative group had higher BC risk estimates using the Gail model. With increasing estimates, discordance also increased, mainly in the FHS-7 positive group. Our results show that in women with a familial history of cancer, the Gail model underestimates risk and the Tyrer-Cuzick seems to be more appropriate. FHS-7 can be a useful tool for the identification of women with higher breast cancer risks in the primary care setting.

Highlights

A wide variety of empiric and mathematical risk assessment models based on personal and familial risk factors have been developed to estimate a woman’s risk of developing breast cancer
It is well known that the short-term and lifetime breast cancer risks assigned to a woman by the Gail and Tyrer–Cuzick models vary considerably
We aim to compare the performance of the Gail and Tyrer-Cuzick models, and assess their concordance in women with and without a positive family history, as assessed by a questionnaire developed to identify high risk patients for hereditary cancer in the primary care setting

Summary

Introduction

A wide variety of empiric and mathematical risk assessment models based on personal and familial risk factors have been developed to estimate a woman’s risk of developing breast cancer. We aim to compare the performance of the Gail and Tyrer-Cuzick models, and assess their concordance in women with and without a positive family history, as assessed by a questionnaire developed to identify high risk patients for hereditary cancer in the primary care setting.

Objectives

Results

Conclusion