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cnn
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A tool available as an online calculator played a key role in actress Olivia Munn’s discovery that she had breast cancer, even after having “a normal mammogram,” according to a social media post.
The “X-Men: Apocalypse” star, 43, he wrote in an Instagram post. She was diagnosed with breast cancer last year on Wednesday and would not have discovered it if her doctor, Dr. Thaïs Aliabadi, had not calculated her breast cancer risk score.
Using that assessment, Aliabadi found that Munn’s lifetime risk of breast cancer was 37%. Because of that score, Munn underwent additional evaluations that led to her diagnosis, according to her post.
A breast cancer risk assessment tool uses a statistical model to estimate a woman’s risk of developing breast cancer over the next five years and throughout her lifetime, or until approximately age 90, depending on the National Cancer Institute.
The tool typically involves several questions about the person’s medical history, reproductive history, and family history. Although it is usually used by health professionals, patients can also take the assessment online.
Two models are commonly used as breast cancer risk assessment tools: the Gail model and the Tyrer-Cuzick Risk Assessment Calculator. An online version of the breast cancer risk assessment tool, which uses the Gail model, is available for anyone to take bcrisktool.cancer.gov. It reveals the patient’s estimated five-year risk and lifetime risk of developing breast cancer, along with the average risk for women in the United States of her age and race.
“Although a woman’s risk can be accurately estimated, these predictions do not allow us to say precisely which woman will develop breast cancer. In fact, some women who do not develop breast cancer have higher risk estimates than some women who do develop breast cancer,” according to the National Cancer Institute website.
A family history of breast cancer or other cancers is often the reason a doctor might perform a breast cancer risk assessment for their patient, and that’s quite common for a doctor to do, said Dr. Jennifer Plichta. , director of the Breast Risk Assessment Clinic at the Duke Cancer Institute in Durham, North Carolina.
“Personally, I think every woman should know what her risk of breast cancer is. I don’t care if you think you’re low risk or high risk. I think it’s worth at least some discussion. In general, many organizations say conversations should start around age 25,” Plichta said.
“When your doctor asks you a bunch of questions and seems like he’s being nosy, in reality he’s probably doing some kind of informal risk assessment in his head,” he said. “Then you could take the next step and do what we call a formal risk assessment, and start using a mathematical model that has been developed to determine a woman’s risk.”
If someone performs their own risk assessment online, they should discuss the results with their doctor, Plichta said.
“Anyone doing one of these online risk assessments should probably follow up with a conversation with their provider, just to make sure they understand the significance of what they discovered and that they did it correctly.” Plichta said.
“There are definitely times where I’ve had patients that we thought might be high risk, and I did a little more nuanced or detailed risk assessment, and they weren’t. And the opposite has happened to me too,” she said. “That’s why I think online tools are great for starting a discussion. Some of these online models are a bit generic. “They’re helpful, they definitely have a role and it’s a good starting point, but I don’t think it ends the conversation there.”
A breast cancer risk assessment tool typically asks for the patient’s age, the age of her first menstrual period, whether she had a breast biopsy, the age at which she may have had a full-term pregnancy, and her family history. of breast cancer. , among other factors, Dr. Otis Brawley, a professor of oncology and epidemiology at Johns Hopkins University, said in an email Wednesday.
All of those factors are entered into an algorithm that calculates the risk score. Some people may score high even if they do not have known genetic mutations associated with an increased risk of breast cancer.
“It’s a way to determine who is at high risk and who is at normal or low risk,” Brawley said, adding that the average risk for a 40-year-old woman is typically 0.9% for five years and about 12% for all his life.
“It has some caveats, such as it may underestimate risk in black women with prior biopsies and in Hispanic women born outside the U.S.,” Brawley said of the screening tools.
“I prefer women to do this with a doctor or genetic counselor who knows the drawbacks,” she said. “The tool is useful, but it can make a woman worry that her risk is higher than she really is or give false assurance that someone is at low risk.”
Someone who scores high on a breast cancer risk assessment may be recommended additional breast screening in addition to a typical mammogram, an X-ray image of the breast.
In Munn’s case, she was sent for an MRI or breast MRI, which led to an ultrasound and then a biopsy, she wrote in her Instagram post.
“The reason a person might have an MRI would be because they are estimated to have an increased risk of breast cancer based on mathematical modeling,” said Dr. Larry Norton, a breast oncologist and medical director at Evelyn H. Lauder Breast Center at Memorial Sloan Kettering Cancer Center.
Mammograms evaluate two things, she said: the density of the breast tissue and calcifications in the breast, which are calcium deposits within the breast tissue.
However, “MRIs look for blood vessels, because one of the things that cancers do when they become cancerous is develop abnormal blood vessels,” Norton said.
“That is why MRIs complement mammograms. In most people they do not replace mammograms,” he said. “In many high-risk people we now do mammograms and MRIs.”
For some women, a breast risk assessment tool may not be as accurate or appropriate, Robert Smith, senior vice president of cancer early detection science at the American Cancer Society, said in an email Wednesday.
“Women should be aware of the disclaimers regarding use of the tool in women with a history of breast cancer or who are carriers of a breast cancer susceptibility gene mutation. “If a woman has a history of multiple first- and second-degree relatives diagnosed with breast cancer, this tool is not appropriate for them,” she wrote.
“For a woman who is at higher risk because of her family history, there are tools that are tailored to her circumstances,” she said. “Most women are in the average risk range, and the tool would not suggest that they should be screened differently than currently recommended.”
In a draft recommendation last year, the U.S. Preventive Services Task Force proposed that all women at average risk for breast cancer begin screening with mammograms at age 40 to reduce their risk. of dying from the disease.
He USPSTF is a group of independent medical experts whose recommendations help guide doctors’ decisions and influence insurance plans, and that draft recommendation aligns with what some groups, such as the American Cancer Society, have been recommending: that Women at average risk start getting mammograms in their 40s.
He The American Cancer Society recommends women who are at high risk of breast cancer due to certain factors get a breast MRI and a mammogram every year, generally starting at age 30.
Having access to a breast cancer risk assessment tool empowers patients, Dr. Ruth Oratz, a breast medical oncologist at NYU Langone Health Perlmutter Cancer Center and clinical professor of medicine at the School of Medicine, said in an email. of NYU Grossman Medicine.
“Having information empowers patients. It is very important for people to be aware of their health risks, their family history, and their own personal medical conditions. All of these things can affect the risk of developing cancer,” he said.
“Depending on the level of risk and the factors that contribute to that risk, women can take steps to help reduce the chance of developing breast cancer. It is important to have a healthy body weight and not be overweight. It is important to eat a healthy diet that is not overloaded with sugar and fat. “Alcohol is a major risk factor for breast cancer and we recommend that women do not drink alcohol every day and do not have more than one or two drinks on the days they drink,” Oratz said.
“We certainly recommend that people not smoke. Staying in good physical shape with exercise and some weight training to maintain muscle mass and strength also contributes to overall health,” she said. “Sometimes medications are given to help reduce the risk of breast cancer. “Each individual should discuss this with a breast cancer expert.”
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