Calculator: Breast cancer risk assessment by Gail Model (2018)

Notes

This tool has been validated for White females, Black/African American females, Hispanic females, and Asian and Pacific Islander females in the United States. The tool may underestimate risk in Black females with previous biopsies and Hispanic females born outside the United States. Because data on American Indian/Alaska Native females are limited, their risk estimates are partly based on data for White females and may be inaccurate. Further studies are needed to refine and validate these models.
This calculator is not appropriate for females with a history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), or previous radiation therapy to the chest for the treatment of Hodgkin lymphoma.
It is also not appropriate for females with a mutation in either the BRCA1 or BRCA2 gene or with a genetic syndrome that may be associated with an elevated risk of breast cancer.
First-degree relatives are female birth parent, female siblings, and female offspring.
The risk codes above (eg, 0 for "NBiop") are based on data for non-Hispanic White females. Some recoding is done for other groups:
- For Hispanic females, NBiop remains coded as 0 for no biopsies, and NBiop is recoded to 1 for 1 or more biopsies. For the Age1st risk factor in the Hispanic groups, <20 years remains coded as 0, 20 to 29 years is recoded to 1, and 30+ years or nulliparous is recoded to 2.
- For African American females, AgeMen of 7 to 11 years is grouped with AgeMen of 12 to 13 years.
- For Asian American females and for US- and foreign-born Hispanic females, an NRels response of none remains coded as 0; for 1 or more first-degree relatives with breast cancer, NRels is recoded to 1.
- For non-Hispanic White females and Native American including Alaska Native females, average 5-year and lifetime absolute risk calculations use the WhiteAvg cancer incidence data (h1) and competing mortality data (h2). Average risk calculations for all other groups use their own cancer incidence data (h1) and competing mortality data (h2).

Calculation details and variables

REN: Race-Ethnicity-Nativity codes; T1 is the age at the start of the risk interval (typically current age); T2 is the age at the end of the risk interval; T2 is set to 90 years old for lifetime risk calculation.
REN_Beta = REN when REN is ≤6. For REN >6 REN_Beta is set to 6.
NumbrIntvl = T2(rounded up) - T1(rounded down)
Absolute risk is calculated by looping through the next steps with index jj spanning jj = 1 to jj = NumbrIntvl:
- if ((NumbrIntvl >1) and (jj >1) and (jj <NumbrIntvl)) IntgrlLngth = 1
- else if ((NumbrIntvl >1) and (jj = 1)) IntgrlLngth = 1 - (T1 - T1(rounded down))
- else if ((NumbrIntvl >1) and (jj = NumbrIntvl)) IntgrlLngth = (T2 - T2(rounded down)) * (T2 >T2(rounded down)) + (T2 = T2(rounded down))
- else if (NumbrIntvl = 1) IntgrlLngth = T2 - T1
- ARxRR = AR50[age category above or below 50][REN_Beta] * Relative Risk[age category above or below 50]
- Hj = (h1 * ARxRR) + h2 where h1 and h2 are the AgeGrp-REN coefficients from the h1 and h2 tables below
- PIj = ((ARxRR * h1 / Hj) * e^{(-CumulativeH)}) * (1 - e^{(-Hj * IntgrlLngth)})
- CumulativeH = CumulativeH + Hj * IntgrlLngth
- RskWrk = RskWrk + PIj
When the loop is complete, the final risk percentage is: 100 * RskWrk
Average risks are calculated by ignoring the patient relative risks, and setting ARxRR to 1 in the loop above.

Natural log relative risk factors (beta coefficients)

Variable	White	AfrnAmrcn	HispUSBorn	HispForgnBorn	NativAmrcn	AsianAmrcn
NBiop	0.529264	0.182212	0.097078	0.479862	0.529264	0.552636
AgeMen	0.094010	0.267253	0	0.259392	0.094010	0.074993
Age1st	0.218626	0	0.231837	0.466925	0.218626	0.276383
NRels	0.958303	0.475724	0.166685	0.907668	0.958303	0.791856
A50*NBiop	-0.288042	-0.111941	0	0	-0.288042	0
Age1st*NRels	-0.190811	0	0	0	-0.190811	0

Attributable risk (AR50 coefficients)

Age	White	AfrnAmrcn	HispUSBorn	HispForgnBorn	NativAmrcn	AsianAmrcn
Age <50	0.578841	0.729499	0.749295	0.428865	0.578841	0.475198
Age ≥50	0.578841	0.743971	0.778215	0.450352	0.578841	0.503164

Breast cancer composite incidences (h1 coefficients)

AgeGrp	Ages	White	AfrnAmrcn	HispUSBorn	HispForgnBorn	NativAmrcn	Chinese	Japanese	Filipino	Hawaiian	OtrPacIsl	OtrAsian	WhiteAvg
1	20-24	0.0000100	0.0000270	0.0000166	0.0000102	0.0000100	0.0000041	0.0000000	0.0000075	0.0000451	0.0000000	0.0000124	0.0000122
2	25-29	0.0000760	0.0001130	0.0000741	0.0000531	0.0000760	0.0000459	0.0000995	0.0000811	0.0000986	0.0000715	0.0000595	0.0000741
3	30-34	0.0002660	0.0003109	0.0002740	0.0001578	0.0002660	0.0001883	0.0002870	0.0002275	0.0003400	0.0002888	0.0001843	0.0002297
4	35-39	0.0006610	0.0006764	0.0006099	0.0003602	0.0006610	0.0004929	0.0005453	0.0005498	0.0008526	0.0006023	0.0004547	0.0005649
5	40-44	0.0012650	0.0011944	0.0012225	0.0007617	0.0012650	0.0009136	0.0011522	0.0011294	0.0016686	0.0007556	0.0007913	0.0011645
6	45-49	0.0018660	0.0018739	0.0019027	0.0011599	0.0018660	0.0014715	0.0018592	0.0018139	0.0025527	0.0007664	0.0010485	0.0019525
7	50-54	0.0022110	0.0024150	0.0023142	0.0014111	0.0022110	0.0014213	0.0026063	0.0022237	0.0033218	0.0018931	0.0013725	0.0026154
8	55-59	0.0027210	0.0029111	0.0028357	0.0017245	0.0027210	0.0019709	0.0032218	0.0026803	0.0053730	0.0023656	0.0014955	0.0030279
9	60-64	0.0033480	0.0031013	0.0031144	0.0020619	0.0033480	0.0016747	0.0040070	0.0028912	0.0052378	0.0028439	0.0016467	0.0036757
10	65-69	0.0039230	0.0036656	0.0030794	0.0023603	0.0039230	0.0018216	0.0035217	0.0025344	0.0055817	0.0029209	0.0014784	0.0042029
11	70-74	0.0041780	0.0039313	0.0033344	0.0025575	0.0041780	0.0018345	0.0035930	0.0024572	0.0056774	0.0023304	0.0012160	0.0047308
12	75-79	0.0044390	0.0040895	0.0035082	0.0028227	0.0044390	0.0019199	0.0035893	0.0022866	0.0065134	0.0020363	0.0010677	0.0049425
13	80-84	0.0044210	0.0039679	0.0025308	0.0028295	0.0044210	0.0022334	0.0035385	0.0018148	0.0038895	0.0014827	0.0013761	0.0047976
14	85-89	0.0041090	0.0036371	0.0020414	0.0025868	0.0041090	0.0022473	0.0020516	0.0017509	0.0029491	0.0010122	0.0006616	0.0040106

Competing mortality excluding breast cancer (h2 coefficients)

AgeGrp	Ages	White	AfrnAmrcn	HispUSBorn	HispForgnBorn	NativAmrcn	Chinese	Japanese	Filipino	Hawaiian	OtrPacIsl	OtrAsian	WhiteAvg
1	20-24	0.0004930	0.0007435	0.0003561	0.0003129	0.0004930	0.0002106	0.0001736	0.0002291	0.0005635	0.0004655	0.0002126	0.0004412
2	25-29	0.0005310	0.0010170	0.0004038	0.0002908	0.0005310	0.0001926	0.0002958	0.0002630	0.0003696	0.0006005	0.0002422	0.0005254
3	30-34	0.0006250	0.0014594	0.0005281	0.0003515	0.0006250	0.0002444	0.0002283	0.0003148	0.0010199	0.0008511	0.0003016	0.0006746
4	35-39	0.0008250	0.0021593	0.0008875	0.0004943	0.0008250	0.0003179	0.0003632	0.0003945	0.0012340	0.0014783	0.0003691	0.0009092
5	40-44	0.0013070	0.0031508	0.0013987	0.0007807	0.0013070	0.0004733	0.0005906	0.0006476	0.0020983	0.0019315	0.0005430	0.0012534
6	45-49	0.0021810	0.0044878	0.0020769	0.0012840	0.0021810	0.0008003	0.0010861	0.0011702	0.0029829	0.0038666	0.0008939	0.0019570
7	50-54	0.0036550	0.0063228	0.0030912	0.0020325	0.0036550	0.0012175	0.0018600	0.0018094	0.0054024	0.0049249	0.0015152	0.0032984
8	55-59	0.0058520	0.0096304	0.0046960	0.0034533	0.0058520	0.0020998	0.0032166	0.0026142	0.0095915	0.0081771	0.0025747	0.0054622
9	60-64	0.0094390	0.0147182	0.0076050	0.0058674	0.0094390	0.0034369	0.0047194	0.0044833	0.0163155	0.0086382	0.0043244	0.0091035
10	65-69	0.0150280	0.0211630	0.0120555	0.0096888	0.0150280	0.0060974	0.0085353	0.0073937	0.0201522	0.0189747	0.0074196	0.0141854
11	70-74	0.0238390	0.0326604	0.0193805	0.0154429	0.0238390	0.0106645	0.0124335	0.0122331	0.0273548	0.0292576	0.0132518	0.0225935
12	75-79	0.0388320	0.0456409	0.0288386	0.0254675	0.0388320	0.0201487	0.0202302	0.0211271	0.0504470	0.0384090	0.0222914	0.0361146
13	80-84	0.0668280	0.0683519	0.0429634	0.0448037	0.0668280	0.0379908	0.0377255	0.0379370	0.0722620	0.0528696	0.0417466	0.0613626
14	85-89	0.1449080	0.1327126	0.0740349	0.1125678	0.1449080	0.0983339	0.1061491	0.0851385	0.1458445	0.0747457	0.0874858	0.1420663

Age
Race/ethnicity/nativity (REN)
Number of prior breast biopsies (NBiop)	No biopsies (0)
	1 biopsy (1)
	2 or more biopsies (2)
	Unknown (0)
Biopsies with atypical hyperplasia (HyperPlasia)	No (-0.0725707)
	Yes (0.5988365)
	Unknown (0)
Age at menarche (AgeMen)	7 to 11 years old (2)
	12 to 13 years old (1)
	14 years or older (0)
	Unknown (0)
Age at first live birth (Age1st)	<20 years old (0)
	20 to 24 years old (1)
	25 to 29 years old (2)
	30 or more years old (3)
	Nulliparous (2)
	Unknown (0)
First-degree relatives with breast cancer (NRels)	None (0)
	1 relative (1)
	2 or more relatives (2)
	Unknown (0)


Relative risk when less than 50 years old
Relative risk when 50 or more years old

Average 5-year risk of breast cancer for a female of the same age and race/ethnicity in the general US population
Average lifetime risk of breast cancer for a female of the same age and race/ethnicity in the general US population

Patient 5-year risk of breast cancer
Patient lifetime risk of breast cancer

Decimal precision

خرید پکیج

Calculator: Breast cancer risk assessment by Gail Model (2018)