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

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

 
Input
 
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)

 
Results
 
Important: Inputs must be complete to perform calculation.

 
 
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  
 

 
 

 

 
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).

 
Equations used
 
LogRR= (NBiop * NB_data[REN_Beta]) + (AgeMen * AM_data[REN_Beta]) + (Age1st * AF_data[REN_Beta]) + (NRels * NR_data[REN_Beta]) + (Age1st * NRels * AFNR_data[REN_Beta]) + HyperPlasia
LogRR50 = LogRR + (NBiop * A50NB_data[REN_Beta])
RRisk = e(LogRR)
RRisk50 = e(LogRR50)

 

 
Calculation details and variables
  • All equation variable values are found in the appendix tables below.
  • 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.

 
Equation parameters, such as Number of prior breast biopsies (NBiop), have more than one discrete value that may be used in the calculation. The numbers in the parentheses, eg, (0), represent the values that will be used.
 

 

 
Appendix

 
Natural log relative risk factors (beta coefficients)
 
VariableWhiteAfrnAmrcnHispUSBornHispForgnBornNativAmrcnAsianAmrcn
NBiop0.5290.1820.0970.4800.5290.553
AgeMen0.0940.26700.2590.0940.075
Age1st0.21900.2320.4670.2190.276
NRels0.9580.4760.1670.9080.9580.792
A50*NBiop-0.288-0.11200-0.2880
Age1st*NRels-0.191000-0.1910

 
Attributable risk (AR50 coefficients)
 
AgeWhiteAfrnAmrcnHispUSBornHispForgnBornNativAmrcnAsianAmrcn
Age <500.5790.7290.7490.4290.5790.475
Age ≥500.5790.7440.7780.4500.5790.503

 
Breast cancer composite incidences (h1 coefficients)
 
AgeGrpAgesWhiteAfrnAmrcnHispUSBornHispForgnBornNativAmrcn ChineseJapaneseFilipinoHawaiianOtrPacIslOtrAsianWhiteAvg
120-240.0000.0000.0000.0000.0000.0000.0000.0000.0000.0000.0000.000
225-290.0000.0000.0000.0000.0000.0000.0000.0000.0000.0000.0000.000
330-340.0000.0000.0000.0000.0000.0000.0000.0000.0000.0000.0000.000
435-390.0010.0010.0010.0000.0010.0000.0010.0010.0010.0010.0000.001
540-440.0010.0010.0010.0010.0010.0010.0010.0010.0020.0010.0010.001
645-490.0020.0020.0020.0010.0020.0010.0020.0020.0030.0010.0010.002
750-540.0020.0020.0020.0010.0020.0010.0030.0020.0030.0020.0010.003
855-590.0030.0030.0030.0020.0030.0020.0030.0030.0050.0020.0010.003
960-640.0030.0030.0030.0020.0030.0020.0040.0030.0050.0030.0020.004
1065-690.0040.0040.0030.0020.0040.0020.0040.0030.0060.0030.0010.004
1170-740.0040.0040.0030.0030.0040.0020.0040.0020.0060.0020.0010.005
1275-790.0040.0040.0040.0030.0040.0020.0040.0020.0070.0020.0010.005
1380-840.0040.0040.0030.0030.0040.0020.0040.0020.0040.0010.0010.005
1485-890.0040.0040.0020.0030.0040.0020.0020.0020.0030.0010.0010.004

 
Competing mortality excluding breast cancer (h2 coefficients)
 
AgeGrpAgesWhiteAfrnAmrcnHispUSBornHispForgnBornNativAmrcn ChineseJapaneseFilipinoHawaiianOtrPacIslOtrAsianWhiteAvg
120-240.0000.0010.0000.0000.0000.0000.0000.0000.0010.0000.0000.000
225-290.0010.0010.0000.0000.0010.0000.0000.0000.0000.0010.0000.001
330-340.0010.0010.0010.0000.0010.0000.0000.0000.0010.0010.0000.001
435-390.0010.0020.0010.0000.0010.0000.0000.0000.0010.0010.0000.001
540-440.0010.0030.0010.0010.0010.0000.0010.0010.0020.0020.0010.001
645-490.0020.0040.0020.0010.0020.0010.0010.0010.0030.0040.0010.002
750-540.0040.0060.0030.0020.0040.0010.0020.0020.0050.0050.0020.003
855-590.0060.0100.0050.0030.0060.0020.0030.0030.0100.0080.0030.005
960-640.0090.0150.0080.0060.0090.0030.0050.0040.0160.0090.0040.009
1065-690.0150.0210.0120.0100.0150.0060.0090.0070.0200.0190.0070.014
1170-740.0240.0330.0190.0150.0240.0110.0120.0120.0270.0290.0130.023
1275-790.0390.0460.0290.0250.0390.0200.0200.0210.0500.0380.0220.036
1380-840.0670.0680.0430.0450.0670.0380.0380.0380.0720.0530.0420.061
1485-890.1450.1330.0740.1130.1450.0980.1060.0850.1460.0750.0870.142

 
Only digits 0 to 9 and a single decimal point (".") are acceptable as numeric inputs. Attempted input of other characters into a numeric field may lead to an incorrect result.

Information on this page may not appear correctly if printed.

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