Priscilla A. Furth, M.D., can imagine a day when breast cancer risk assessment is as simple and accurate as testing for heart disease risk. Like a blood test to check cholesterol levels, fi ne-needle aspiration could remove a few cells from the breast to look at genetic markers in young women. “You wouldn’t even need a piece of tissue, just some cells,” said the professor of oncology and medicine at Lombardi Comprehensive Cancer Center at Georgetown University Medical Center in Washington, D.C. “It’s a little dreamy, but it’s feasible.” Furth and many others are working hard to improve breast cancer risk assessment. But so far, the only well-tested way to gauge breast cancer risk is through models that use a few self-reported factors, including age, reproductive history (age at onset of menstruation, fi rst live birth), whether a mother or sister had breast cancer, and previous history of breast cancer. The Breast Cancer Risk Assessment Tool (BCRAT), also known as the Gail model, is one example. Unfortunately, existing models are more helpful in looking at populations than at specifi c women. “Our ability to assess risk at an individual level is somewhat lacking,” said Eitan Amir, M.D., who recently evaluated six assessment tools with his colleagues from the Division of Medical Oncology and Hematology at Princess Margaret Hospital in Toronto. “We need to improve those models.” Genomewide association studies linked several genetic variations, single-nucleotide polymorphisms (SNPs), to breast cancer. Adding those to the assessments makes sense. But the known genetic variations, except for the clearly infl uential BRCA1 and BRCA2 mutations, don’t yet give enough information to make them worth using, according to a National Cancer Institute study published in March in the New England Journal of Medicine. Meanwhile, the pressure is mounting; several companies are selling their versions of genetic tests to physicians or directly to the public ( see sidebar). The mammography debate (whether screening should begin at age 40 or 50 years) is moving this fi eld along as well. “Risk assessment is sexy again because of the issues related to the U.S. Preventive Services Task Force routine mammography recommendations,” said Susan M. Domchek, M.D. , associate professor of medicine at the Abramson Cancer Center