A Comparison of Perceived Lifetime Breast Cancer Risk to Calculated Lifetime Risk Using the Gail Risk Assessment Tool.
Level 4 - case-series / case-control
Cross-sectional survey study
PubMed 35041492 · doi:10.1089/jwh.2019.8231
What was done
In July 2016, 550 women presenting to Mayo Clinic sites in Arizona and Minnesota completed a survey assessing perceived lifetime breast cancer risk. Calculated lifetime risk was determined using the Gail Risk Assessment Tool based on self-reported health history questions and compared to perceived risk.
What was found
Using the Gail model, 86.6% of women were classified as average risk (<15%), 7.7% as intermediate risk (15%-20%), and 5.6% as high risk (>20%). Of 27 women at high risk, 18 (66.7%) underestimated their risk, and of 37 at intermediate risk, 12 (32.4%) underestimated risk. Underestimation was more common among women reporting an abnormal mammogram history and at least one relative with breast cancer. Overall, surveyed women were 4.3 times (130/30) more likely to overestimate than underestimate risk.
Why it matters
Although most women in a general clinical sample overestimate their breast cancer risk, the majority of women at highest calculated risk underestimate theirs, identifying a target for shared screening decision-making.
Limits
The study was a cross-sectional convenience sample restricted to predominantly white, married, and well-educated women at a single health system during one month. Risk calculations relied on self-reported health history rather than clinical record validation.
Cited by
- supports Breast cancer risk models categorize low risk as less than 15%, intermediate risk as 15% to 20%, and high risk as 20% or greater lifetime risk.