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 AtypHyperFiveYearRisk = RelativeRisk x BaselineAgeRace
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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 AtypHyperFiveYearRisk = 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). |
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| NumBiops | If Age <50 years: 1.0 (no biopsies); 1.7 (one biopsy); 2.88 (two or more biopsies). |
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| If age ≥50 years: 1.0 (no biopsies); 1.27 (one biopsy); 1.62 (two or more biopsies). |
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| 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). |
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| 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 · 12:00 AM
Last Checked: October 24, 2020
Next Review: October 24, 2025