What's your breast cancer risk? Here's how to use assessment quizzes, check for symptoms and more.
Searches for breast cancer symptoms soared by as much as 300% in the day after actress Olivia Munn announced her breast cancer diagnosis. Searches for breast cancer risk assessment tools like the one Munn used spiked as well. In a post she shared on Instagram, Munn urged all women to ask their health care providers to calculate their risks using these tools, which are also available to the public online. But breast cancer risk assessment quizzes aren't the only way to catch tumors early. Here’s what experts have to say about breast cancer risk assessment tools and screenings, as well as symptoms to look out for.
What are breast cancer risk assessment tools, and how do they work?
These tools are basically calculators, but instead of numbers, they use information about your medical history, your family health history, your age, race, reproductive history and in some cases your height and weight to estimate your breast cancer risk.
A number of different tools exist, but the two most commonly used ones are the Breast Cancer Risk Assessment Tool (BCRAT, formerly called the “Gail Model”) and the International Breast Cancer Intervention Study (IBIS) model, previously called the Tyrer-Cuzick Risk Assessment Calculator. Both are available online and are free to use.
The BCRAT “tends to underestimate the risk a little because it is very simple and doesn’t have a lot of different things you have to answer,” Dr. Jason Mouabbi, a breast oncologist with MD Anderson Cancer Center, tells Yahoo Life. On the other hand, the IBIS tool tends to overestimate risks, he says. That’s because it requires more information. Mouabbi uses both tools to get the most accurate picture of someone’s risks.
Using the IBIS tool will tell you your risk of developing breast cancer in the next 10 years and over your lifetime, while the BCRAT tool provides your five-year and lifetime risks (up to age 90). Both tests should be used only by adults.
A lifetime risk score of 20% or above (generally calculated by the IBIS model) is considered high risk. Using the BCRAT test, a five-year risk of more than 1.66% is considered high. But there are some important caveats and considerations for what those scores mean, as well as other important factors and symptoms to pay attention to.
Important things to know before using breast cancer risk assessment tools
First of all, it’s best to have your health care provider do your assessment for you. “You really don’t want to do it wrong, because it can lead to unnecessary anxiety,” Mouabbi says. These risk assessment quizzes are well known to oncologists, but any health care provider can help you take one.
Second, the tools may be less accurate for younger people. The BCRAT calculator says it’s only supposed to be used to calculate the risks for women between the ages of 35 and 85. The IBIS model doesn’t note any age limitations, but Mouabbi says he only uses either calculator to calculate risks for those ages 30 and older.
Most importantly, these assessment tools should only be used by people who have an “average” risk of breast cancer. In the U.S., there is a 1 in 8 chance that a woman will develop breast cancer, according to the American Cancer Society (ACS). But when it comes to using a risk assessment tool, the difference between an average and a high risk of breast cancer really refers to whether or not someone has tested positive for mutations to the BRCA genes that are linked to higher risks of breast cancer.
Find out your family history and genetic risk
One of the most important steps you can take to understand your breast cancer risks — with or without using an assessment tool — is to find out your family health history, which is a major factor in the risk calculation.
If you decide to use a risk assessment tool on your own, “you should try to talk to a health care provider to see if you’ve used the right risk assessment test based on your family history,” Susan Brown, a registered nurse and senior director of health information and publications at the Susan G. Komen Foundation, tells Yahoo Life.
Most people who develop breast cancer do not have a family history of the disease. But having a first-degree relative such as a sister, mother or daughter who has had breast cancer puts a person at about double the risk of having it themselves, according to Breastcancer.org.
There are a handful of genes and genetic mutations that are linked to greater risks of breast cancer, including BRCA1 and BRCA2 mutations. Because breast cancer appears to run in families beyond these genes, scientists assume that there are other genetic factors that haven't yet been identified, meaning family history is an important risk factor even if you know you don't carry these mutations.
People who know they have these mutations — based on genetic testing — are already at high risk and should be taking precautions, rather than relying on risk assessment quizzes, Mouabbi says. “Those mutations do not skip generations,” he says. “Someone in the family will already have had it.” A family history of breast cancer is a good reason to get BRCA testing, which can cost anywhere from $250 to $5,000, but may be covered by insurance.
About 1 in every 500 women in the U.S. has a mutation in either the BRCA1 or BRCA2 gene, according to the Centers for Disease Control and Prevention (CDC). These mutations are estimated to increase the risk of breast cancer four- to seven-fold and put carriers at a 10% to 46% higher risk of ovarian cancer.
But, says Brown, “all people are at risk for breast cancer — even men get breast cancer.” Even if risk assessment tools and genetic screening results don't “raise any red flags, it doesn’t mean they shouldn’t talk to their health care provider” about screening and prevention, she says.
What to do once you know your risk
If your breast cancer risk is below 20%, your health care provider is more likely to advise you to follow standard screening recommendations and get mammograms annually starting as early as age 40. If you’ve had a mammogram, radiologists will be able to tell you if you have dense breasts and should get additional screening. Whatever your score is, remember that it changes over the course of your life, so if you score under 20% one year, you shouldn’t assume you’ll remain low-risk the next, Mouabbi cautions.
Those who score 20% or above should start to get more frequent and additional screenings, such as MRIs and ultrasounds, which can help detect breast cancer cases sometimes missed by mammography. The good news, Mouabbi says, is that having a high risk score should automatically mean your insurance has to cover additional screening, which can otherwise get expensive.
It also makes you eligible for preventative treatment, he says. Some women with a high risk of breast cancer can be prescribed tamoxifen; the estrogen-blocking drug is used to treat breast cancer at high doses, but it can also be used at lower doses to reduce risks by 43%, according to one University of Toronto study.
Know the common symptoms of breast cancer — and your body
Knowing your risk based on quiz scores can help you and your health care provider come up with the right screening and prevention strategies. But Brown notes that there’s no substitute for simply knowing and paying attention to your own body.
Experts, including both the U.S. Preventive Services Task Force (USPSTF) and the ACS, no longer recommend routine breast self-exams because habitually checking for lumps has not been shown to improve survival odds for women with breast cancer. However, there's still value in people “knowing what's normal for them,” says Brown, and taking note when something changes. That means keeping an eye out for:
Changes in the size or shape of one or both of your breasts
Skin dimpling (which can make your breast look as if it has a texture like an orange peel)
Pain in your breast or nipple
A nipple turning inward
Red, flaky, dry or thick nipple or breast skin
Nipple discharge
Swollen lymph nodes (usually under the arm or around the collarbone)
“If you notice a change in your breast or underarm, do not sit at home and wonder about it, do not consult Dr. Google; go see your health care provider,” says Brown. Half of women ages 50 and over and 70% of women under 50 who are diagnosed with breast cancer get that diagnosis by detecting a change themselves, according to the American College of Obstetricians and Gynecologists (ACOG).
“Most people who find a change in their breast don’t turn out to have breast cancer,” Brown says. “But those changes are found when women are just going about their daily lives — showering, dressing or a partner finding a change — so it’s important for women to know those warning signs and be conscious of changes in their own bodies.”
