Letters

RAPID RESPONSE FROM BMJ.COM

The National Cancer Institute's Breast Cancer Risk Assessment Tool

This article originally appeared in BMJ USA

EDITORI use the National Cancer Institute's Breast Cancer Risk Assessment Tool for risk stratification. This is the software tool used in the Breast Cancer Prevention Trial with tamoxifen. It uses the "Gail model," which includes known risk factors such as age, personal history of breast abnormalities, age at menarche, age at first live birth, family history, breast biopsies, and race. I have the software both on a PC and on my Palm PDA (Personal Digital Assistant).* A PDA Gail model program is available at http://pbrain.hypermart.net/medrules.html.

I give the patient her five-year risk of breast cancer, and I offer her mammography if she wishes. Mammograms after the age of 50 offer a mortality reduction of about 25%; due to the greater likelihood of rapid progression in younger women, they should have mammograms yearly instead of every two years.

Perhaps the time has come to offer risk stratification at the bedside, based on multifactorial risk analysis. This is now possible. I tend to use the Palm version more often than the PC version, because of its easy accessibility.

Michelle Greiver, lecturer. 
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada mgreiver{at}home.com

Information about the Breast Cancer Risk Assessment Tool can be found on the National Cancer Institute's web site at http://bcra.nci.nih.gov/brc/. That site offers an online version of the assessment tool, from which a patient's risk of breast cancer can be calculated and printed. By searching for "Breast Cancer Risk Assessment Tool" using the google.com search engine, you can find several web sites from which the assessment tool can be downloaded. One such site is http://oncolink.upenn.edu/disease/breast/cause/breastca_risk/EDITOR