Gail Model for Breast Cancer Risk

Determines relative and five-year risk of breast malignancy based on patient and clinical data from the validated Gail Model 1 (1999).

Refer to the text below the calculator for more information about the model and the variables involved.


The validated Gail Model 1 (1999) for breast cancer risk helps guide clinicians towards the appropriate risk-reduction option (if >1.7% chemoprevention with tamoxifen), surgical (prophylactic mastectomy) or lifestyle changes.

The Gail Model is addressed to women of 20 to 84 years of age, with NO:

  • history of breast cancer;
  • ductal carcinoma in situ (DCIS);
  • lobular carcinoma in situ (LCIS);

and may not be appropriate for women with known mutations in:

  • BRCA1;
  • BRCA2;
  • or other hereditary syndromes.

Increased risk of breast cancer is defined as a 5-year risk of breast cancer greater than 1.7%. Patients with such scores are candidates for chemoprevention (such as tamoxifen).

  • RelativeRisk = AgeMenarche x NumBiops x AgeFLBNumRels x AtypHyper
  • FiveYearRisk = RelativeRisk x BaselineAgeRace

Age (between 20 - 84 years)
Race/Ethnicity
First menstrual period
First live birth
First-degree relatives with breast cancer
Previous breast biopsy
Atypical hyperplasia
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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.


 

Gail Model for Breast Cancer Risk

Originally published in 1989, the Gail Model is one of the oldest and well validated models for predicting breast cancer risk. It has subsequently been modified and revalidated in 1999 for the National Surgical Adjuvant Breast and Bowel Project (NSABP) using data from the Breast Cancer Prevention Trial.

The formulas used to determine risk of developing breast cancer include the following variables:

  • RelativeRisk = AgeMenarche x NumBiops x AgeFLBNumRels x AtypHyper
  • FiveYearRisk = RelativeRisk x BaselineAgeRace

Where:

Gail Model for Breast Cancer Risk Variables
AgeMenarche 1.0 (≥ 14 years old);
1.1 (12-13 years old);
1.21 (<12 years old).
NumBiops If Age <50 years:
1.0 (no biopsies);
1.7 (one biopsy);
2.88 (two or more biopsies).
If age ≥50 years:
1.0 (no biopsies);
1.27 (one biopsy);
1.62 (two or more biopsies).
AtypHyper 1.0 (No biopsies);
0.93 (At least one biopsy and no atypical hyperplasia found in any biopsy specimen);
1.0 (No atypical hyperplasia found and hyperplasia status unknown for at least one biopsy specimen);
1.82 (Atypical hyperplasia found in at least one biopsy specimen).
BaselineAgeRace
(depends on age and race)
Age Race: Black Race: White
20-24 0.014 0.012
25-29 0.050 0.049
30-34 0.120 0.134
35-39 0.224 0.278
40-44 0.310 0.450
45-49 0.355 0.584
50-54 0.416 0.703
55-59 0.511 0.859
60-64 0.562 1.018
65-69 0.586 1.116
70-74 0.646 1.157
75-79 0.713 1.140
80-84 0.659 1.006
AgeFLBNumRels
(depends on the age at first live birth and family history of breast cancer)
First-degree relatives with breast cancer
First live birth None One More than one
No births 1.55 2.76 4.91
<20 years old 1.00 2.61 6.80
20-24 years old 1.24 2.68 5.78
25-29 years old 1.55 2.76 4.91
≥30 years old 1.93 2.83 4.17

Increased risk of breast cancer is defined as a 5-year risk of breast cancer greater than 1.7%. Patients with such scores are candidates for chemoprevention (such as tamoxifen).

Please note the 1989 model is addressed to women of 20 to 84 years of age, with no history of breast cancer, ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS) and may not be appropriate for women with known mutations in BRCA1, BRCA2, or other hereditary syndromes (for example, the model underestimates the cancer risk for patients with extensive family history, as it includes only first degree relatives).

The table bellow summarizes the associated ICD9-CM and ICD10-CM codes:

ICD9-CM Codes ICD10-CM Codes
239.3: Breast neoplasm nos C50.919: Malignant neoplasm of unspecified site of unspecified female breast
V10.3: Hx of breast malignancy C50.819: Malignant neoplasm of overlapping sites of unspecified female breast
611.72: Lump or mass in breast N63: Unspecified lump in breast
174.8: Malign neoplasm breast nec Z85.3: Personal history of malignant neoplasm of breast
174.9: Malign neoplasm breast nos D49.3: Neoplasm of unspecified behavior of breast
 

References

Original reference

Gail MH, Brinton LA, Byar DP, Corle DK, Green SB, Shairer C, Mulvihill JJ: Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81(24):1879-86, 1989.

Validation

Costantino JP, Gail MH, Pee D, Anderson S, Redmond CK, Benichou J, Wieand HS: Validation studies for models projecting the risk of invasive and total breast cancer incidence. J Natl Cancer Inst 91(18):1541-8, 1999.

Other references

Amir E, Evans DG, Shenton A et al. Evaluation of breast cancer risk assessment packages in the family history evaluation and screening programme. J Med Genet. 2003; 40:807-814.


Specialty: Oncology

Year Of Study: 1989

Article By: Denise Nedea

Published On: October 24, 2020

Last Checked: October 24, 2020

Next Review: October 24, 2025