Breast cancer risk assessment tool: Observations from an Indian cohort

Abstract Introduction: Breast cancer is now the most common cancer in Indian women and a major health problem. It is multifactorial in causation and the risk is dynamic and changeable over time. A risk assessment tool helps to evaluate an individual’s risk at a particular point in time. The Gail model, available as an online risk calculator, is the most widely used and studied tool for the risk assessment of nonhereditary breast cancer. However, the Gail model was developed for the American population and its applicability and accuracy for the Indian population are not definitely known. Since race is an important risk determinant and it could change with migration of different ethnic groups to different geographical and socio-cultural environments. This observational study highlights the findings regarding Gail model for breast cancer risk in an urban cohort of Indian women. Materials and Methods: Prospectively collected data of women attending the preventive health check-up department of western India were analyzed retrospectively. The online breast cancer risk assessment tool was used to calculate the immediate 5-year risk, lifetime risk, and relative risk (RR) of each individual. Individual risk factors of age at menarche and age at first child were analyzed additionally using the same data set to know their relevance in the Indian setting. Results: The online risk calculator performs more accurately when the resident Indian women are categorized as “Asian American” in the tool even rather than as “unknown” which could be used since they are not resident Americans; categorizing them of “unknown” race doubles the risk score generally. An early menarche and later age of over 30 years at first childbirth remain determinants of higher risk for breast cancer in Indian women. A significantly high risk, defined as RR of more than 1.61 was found in only about 6% in this cohort. Conclusion: In the absence of an algorithm, especially developed for resident Indian women, the online breast cancer risk calculator based on the Gail model was more suitable for risk assessment with race chosen and entered as “Asian American” in the model.