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

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.

The Value of Tyrer-Cuzick Versus Gail Risk Modeling in Predicting Benefit from Screening MRI in Breast Cancer

“…The TC and Gail models vary from the Claus model, as demonstrated in previous studies, with the TC and Gail models estimating a far higher lifetime risk than Claus (26). In fact, a more recent study found significant differences in the number of women that were eligible for MRI screening identified by the risk assessment models utilized in the study (TC, Claus, BRCAPRO) (31). In our study, we demonstrated no statistically significant correlation between the Gail or TC models when utilizing MRI as a screening modality with 20% lifetime risk cutoff to classify patients as high-risk.…”

“…purposes (30). These risk assessment models, while commonly used in clinical practice, have been shown to have significant variability when identifying different populations of women eligible for screening MRI (31).…”

“…Conflicting data exist in the literature regarding the level of accuracy between these two models, with some studies indicating that the TC model is superior in terms of specificity, sensitivity, and positive and negative predictive value (32,33), while others reporting greater AUC and specificity for the Gail model (34,35). Guidelines warn against the use of the Gail model when assessing MRI eligibility for screening purposes due to accounting for limited family history (31). The TC model collects additional data, such as menopausal status, BMI, more extensive family history and the presence of LCIS, which theoretically can increase breast cancer risk prediction (Table 4).…”

Histórico familiar para câncer de mama em mulheres: estudo populacional em Uberaba (MG) utilizando o Family History Screen-7

“…Considerando que a informação sobre o histórico familiar de câncer é pouco explorada e muitas vezes negligenciada na atenção básica, e que há diversos fatores ou barreiras que podem limitar a efetividade do rastreamento mamográfico, quer estejam relacionados ao sistema de saúde, à educação ou à adesão ao exame de mamografia 22 , esse instrumento é indicado como uma ferramenta de fácil aplicação na atenção básica para o rastreamento inicial de mulheres classificadas com o risco familiar para posteriores análises específicas desse risco familiar 26 , podendo trazer mais conteúdo para a formulação de estratégias de abrangência a essa população de provável risco.…”

Supplemental Cancer Screening for Women With Dense Breasts: Guidance for Health Care Professionals

“…137 The American Cancer Society has recommended models that incorporate histories of firstand second-degree relatives (eg, BRCAPRO computer program, Tyrer-Cuzick, Claus) to identify high-risk women who qualify for additional annual screening MRI scans 103 (Table 2). [138][139][140][141][142][143][144][145][146][147][148][149][150][151] Women at high risk should be encouraged to undergo annual supplemental breast MRI screening in addition to regular annual screening mammography either together or in 6-month intervals, irrespective of breast density. 116,152 A few models include modifiable lifestyle risk factors, such as alcohol intake, body mass index, hormone therapy, 141,153,154 and exercise, that improve the breast cancer risk predictive capability.…”