Content area
Full text
Challenges in clinical application
KEYWORDS
breast cancer; breast cancer risk prediction model; risk; genetics; genetic testing
The high incidence of breast cancer (an estimated 266,120 women in the United States in 2018), coupled with women's desire to understand their risk of developing breast cancer, has led to the development of several breast cancer risk prediction models (BCRPMs) (National Cancer Institute [NCI], 2018). There are different models available to calculate breast cancer risk, as well as models to calculate the risk of carrying a pathogenic mutation associated with hereditary risk of developing malignancy. These models can be difficult to implement, interpret, and explain during a fast-paced clinical encounter (Cintolo-Gonzalez et al., 2017). First-generation screening models, including the Gail and Claus models, lack robust analysis and may insufficiently determine risk (Gail, 2015). However, newer generation models are more complicated and pose challenges in interpretation (CintoloGonzalez et al., 2017). When applied correctly, BCRPMs can identify high-risk patients and allow providers an opportunity to have an in-depth conversation with the patient (Cintolo-Gonzalez et al., 2017). This article will present a synopsis of BCRPMs currently used (see Figure 1), with details on application and interpretation for providers as well as implications for oncology nursing practice.
Models
Gail Model
The introduction of tamoxifen as a breast chemoprevention agent was the impetus for the development of the Gail model to identify women who might benefit from chemoprevention (Gail et al., 1989). The original model was based on data collected from Caucasian women, but other races were included in subsequent research (NCI, 2018). The model is easy to implement, and results are understandable for providers and patients.
Gail Model 2/Breast Cancer Risk Assessment Tool
The Gail model 2, also known as the Breast Cancer Risk Assessment Tool (BCRAT), was created to enhance specificity for identifying risk of developing invasive breast cancer. Ten years after the Gail model was initiated, it was modified by adding a variable of "yes/no" for a positive breast biopsy of atypical hyperplasia (Constantino et al., 1999). A limitation of the Gail model 2/BCRAT is that it does not consider paternal relatives or seconddegree relatives diagnosed with breast cancer, so it may underestimate risk in some families (National Comprehensive Cancer Network [NCCN], 2018a). The Gail model and Gail model...