Estimating Breast Cancer Risk (the Gail Model)

Your health care provider looks at which risk factors you have and then estimates your risk of breast cancer.

A few factors, such as having a BRCA1 or BRCA2 inherited gene mutation, are linked to a high risk of breast cancer. However, most known risk factors are linked to a small or modest increase in risk.

Exactly which risk factors should be used to estimate breast cancer risk is still under study.

Although men can get breast cancer, the tools used today to estimate breast cancer risk are only used to estimate risk for women.

Learn more about breast cancer in men.

Learn more about risk factors for breast cancer.

Learn about individual risk versus group risk.

The Breast Cancer Risk Assessment Tool (the Gail Model)

The Breast Cancer Risk Assessment Tool (the Gail model) is often used by health care providers to estimate breast cancer risk. The tool calculates a woman’s risk of developing breast cancer over the next 5 years and within her lifetime (up to age 90). Although this tool can estimate your risk, it can’t tell whether or not you’ll get breast cancer.

The tool uses 7 key risk factors for breast cancer:

Age
Age at first menstrual period
Age at the time of the birth of a first child (or has not given birth)
Family history of breast cancer (mother, sister or daughter)
Number of past breast biopsies
Number of breast biopsies showing atypical hyperplasia
Race/ethnicity

Women with a 5-year risk of 1.67% or higher are classified as “high-risk.” A 5-year risk of 1.67% or higher is the FDA guideline for taking a risk-lowering drug to reduce breast cancer risk.

Individual risk versus group risk

The Breast Cancer Risk Assessment Tool can’t predict whether or not you’ll get breast cancer. It doesn’t calculate an individual woman’s breast cancer risk.

Instead, the tool gives the average risk of breast cancer for a group of women with similar risk factors. It’s not clear what this risk means for any one woman.

Most people diagnosed with breast cancer are at average risk and we don’t know what caused the cancer. Because the disease process is so complex, it’s hard to know how a certain set of risk factors will affect any one person. When we look at groups of people it becomes clearer.

Say the tool gives you a 5-year risk of 1%. This means the tool estimates 1% of women who have risk factors similar to yours will develop breast cancer over the next 5 years. However, the tool can’t predict which of these women will get breast cancer.

How to interpret your estimated breast cancer risk

The Breast Cancer Risk Assessment Tool was designed to be used by health care providers. So, if you use the tool on your own, it may be hard to understand the results and use the information to make decisions about your care.

Talk with your health care provider about your breast cancer risk based on the results of this tool. Then together, you and your provider can make decisions about your breast care. This is called shared decision-making.

Learn more about understanding risk.

Limits of the Breast Cancer Risk Assessment Tool

The Breast Cancer Risk Assessment Tool doesn’t use all the known (established) risk factors for breast cancer to assess risk.

The tool also doesn’t give a good risk estimate for some women, including those with a [1]:

The original model was based on data from white women in the U.S. with data from the National Institutes of Health’s Surveillance, Epidemiology, and End Results (SEER) Program data. The tool can now estimate risk for:

Black women, using data from the Contraceptive and Reproductive Experiences (CARE) Study and SEER
Asian and Pacific Islander women in the U.S., using data from the Asian American Breast Cancer Study and SEER
Hispanic women, using data from the San Francisco Bay Area Breast Cancer Study, the California Cancer Registry, the California SEER Program and SEER

The model may not work as well for other racial and ethnic groups.

Visit the National Cancer Institute website to learn more about the Breast Cancer Risk Assessment Tool.

Other breast cancer risk assessment tools

Some tools, such as IBIS (the Tyrer-Cuzik model) and BOADICEA, use family history and other factors to estimate breast cancer risk. Such tools can be used for women who have one or more relatives with breast cancer or ovarian cancer.

The BWHS (Black Women’s Health Study) Breast Cancer Risk Calculator tool is based on data from Black women in the U.S. The tool uses a woman’s personal and family health history as well as her reproductive history to estimate her breast cancer risk.

The Breast Cancer Surveillance Consortium (BCSC) has a risk calculator that uses a woman’s personal health history, family health history and reproductive history to estimate her breast cancer risk.

Looking ahead at breast cancer risk assessment

As research in risk assessment grows, tools like the Breast Cancer Risk Assessment Tool will be better able to predict breast cancer risk in large groups of women.

Talking with your health care provider about your risk of breast cancer

Watch our video of Komen grantee Dr. Tarah Ballinger who shares why it’s important to know if you’re at higher risk of breast cancer.

If you have questions about your risk of breast cancer, talk with your doctor, nurse or other health care provider.

Your family health history plays a role in your breast cancer risk. Before you meet with your health care provider, it’s helpful to collect information about your family health history.

Information on any cancers diagnosed in both the women and men in your family (and the ages when they were first diagnosed) will be helpful in assessing your breast cancer risk.

If you’re considering genetic testing to learn if a family history of cancer is due to an inherited gene mutation related to cancer risk, talk with your health care provider or a genetic counselor. They can help you decide if genetic testing is right for you and your family.

Learn more about inherited gene mutations.

Learn more about family history of breast cancer and breast cancer risk.

My Family Health History Tool

My Family Health History tool is a web-based tool that makes it easy for you to record and organize your family health history. It helps you gather information that will be useful as you talk with your family members, doctor or genetic counselor.

Updated 03/26/24

This content is regularly reviewed by an expert panel including researchers, practicing clinicians and patient advocates.

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