Breast Cancer Risk Assessment

Among the most important things you can do to reduce your chances of getting breast cancer or to facilitate earlier detection is to know your personal risk of developing breast cancer. Knowing your risk of breast cancer allows you to determine

  1. how often you should be screened
  2. what type of screening you should undergo, and
  3. what type of risk-reduction strategies you should consider to reduce your risk of breast cancer

Below you will find a list of Breast Cancer Risk Assessment Tools that can be used to estimate your risk of developing breast cancer in the next five years or in your lifetime. After you determine your personal risk of breast cancer, use the Personalized Screening and Prevention Guide at the end of this page to determine how you should be screened and how you could reduce your risk of breast cancer. For more information, download and view a Breast Cancer Risk and Assessment slide presentation by Dr. Holmes.

Risk Assessment Tools for Women who are not suspected to be at risk of having hereditary breast cancer.
  1. Gail Breast Cancer Risk Assessment Tool – The most widely used tool for estimating a woman’s 5-year and lifetime risk of developing invasive breast cancer.
  2. Hall Detailed Breast Risk Calculator – A breast cancer risk assessment tool that includes some risk elevating and risk-lowering factors not included in the Gail Tool. A Dr. Holmes favorite.

The Gail Tool and Hall Calculator might underestimate your risk of breast cancer if you have a personal or family history of one of the following:

  • Cancer in multiple generations (e.g., mother and her mother)
  • Two or more people in at same generation with cancer (e.g., mother and her sister)
  • Earlier than expected age of diagnosis (e.g., breast cancer before age 50)
  • Individuals with more than one cancer (e.g., breast cancer and melanoma)
  • Cancers that tend to run together (e.g., breast and ovarian)
  • Cancers associated with BRCA mutations (e.g., Triple Negative Breast cancers)
  • Individuals with cancer in both breasts.

If any of those risks are present in your family, you should use a risk assessment tool for women who are suspected to be at risk of having hereditary breast cancer. See below.

Risk Assessment Tools for Women who are suspected to be at risk of having hereditary breast cancer.
  1. Myriad Risk Table – This is a simple table that is used to estimate the probability of having a BRCA1 or BRCA2 mutation based on your personal and family history of breast and ovarian cancer. Download the Myriad Risk Table
  2. BRCAPRO – This is the most widely accepted tool for determining the lifetime risk of breast, ovarian, colorectal, endometrial, melanoma, and pancreatic cancer based on your family history and family pedigree. This is a downloadable calculator that requires a registration. This tool is best used by a genetic counselor.

Dr. Holmes’ Personalized Prevention Recommendations***
Average RiskModerate RiskModerateHereditary Risk
Lifetime Risk <15%Lifetime Risk 15-20%Lifetime Risk 21-60%Lifetime Risk >60%
  • Eat 5 Serving of Fruits & Veggies daily
  • Exercise at Least 30 minutes daily (or >2.5 hours/week)
  • Drink no more than 1 glass of alcohol daily
  • Do not use Estrogen and Progesterone-containing Hormone replacement therapy for more than 5 years
  • Follow recommendations for the average risk group
  • See a Genetic Counselor
  • Consider taking Tamoxifen, Raloxifene, or Exemestane to reduce your risk of breast cancer
  • Follow recommendations for the average risk group
  • See a Genetic Counselor
  • Consider taking Tamoxifen, Raloxifene, or Exemestane to reduce your risk of breast cancer
  • Consider prophylactic removal of breasts and/or ovaries
  • Follow recommendations for the average risk group
  • See a Genetic Counselor
  • Prophylactic removal of breasts and/or ovaries
  • Take Tamoxifen, Raloxifene, or Exemestane to reduce your risk of breast cancer if you elect not to have prophylactic mastectomy
Dr. Holmes’ Personalized Screening Recommendations***
  • Age 20-39
    • Monthly Breast Self-Exam*
    • Doctor’s Exam at least every 3 years
    Age 40 & Older
    • Monthly Breast Self-Exam*
    • Doctor’s exam yearly
    • Mammograms yearly
Age 18-24
  • Monthly Breast Self-Exam*
  • Doctor’s Exam at least every 2 years
Age 25-34
  • Monthly Breast Self-Exam*
  • Doctor’s exam once or twice each year
Age 35 & Older
  • Monthly Self-Exam*
  • Doctor’s exam twice yearly
  • Mammograms yearly
Age 18-24
  • Monthly Breast Self-Exam*
  • Doctor’s Exam at least every 2 years
Age 25-34
  • Monthly Breast Self-Exam*
  • Doctor’s exam once or twice each year
Age 35 & Older
  • Monthly Self-Exam*
  • Doctor’s exam twice yearly
  • Mammograms yearly
  • Breast MRI yearly***
Age 18-24
  • Monthly Breast Self-Exam*
  • Doctor’s Exam twice yearly
  • Breast MRI yearly***
Age 25-34
  • Monthly Breast Self-Exam*
  • Doctor’s Exam twice yearly
  • Breast MRI yearly***
Age 35 & Older
  • Monthly Breast Self-Exam*
  • Doctor’s Exam twice yearly
  • Mammograms yearly
  • Breast MRI yearly***

*Breast Self-Examination. Any breast lumps that persist for more than 1 month should be brought to the attention of your doctor. ALL lumps should be evaluated with Ultrasound, even if the mammogram is normal. View a video showing a breast self examination technique.

**These are the recommendations of Dr. Holmes based on his interpretation of the best available literature regarding breast cancer screening and prevention.

***Bilateral breast ultrasound or Breast Specific Gamma Imaging may be considered if unable to undergo breast MRI.

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