MIAMI BEACH, FloridaThe Breast Cancer Risk Assessment Working
Group is completing work on its consensus guidelines for stratifying patients
into risk categories for breast cancer and managing their care accordingly. The
model was outlined at the 19th Annual Miami Breast Cancer Conference.
The Risk Assessment Working Group
"This ongoing effort aims to marry evidence-based medicine with a
pragmatic approach, to spur further clinical research and to help practitioners
manage these high-risk women," said founding member Joyce O’Shaughnessy,
MD, Baylor-Sammons Cancer Center/US Oncology, Dallas. The new guidelines, for
example, suggest the use of ductal lavage to look for atypical cells as a
pragmatic tool to help high-risk women make decisions regarding chemoprevention.
Although accurate tools to assess breast cancer risk have been available for
some time, the Working Group effort is perhaps the first to suggest specific
risk reduction strategies based on a woman’s risk assessment. "Because
we now have interventions, such as tamoxifen [Nolvadex], with many others
coming down the pike, it’s really time to identify women who might benefit
from these interventions," Dr. O’Shaughnessy said.
The Working Group’s chair, Victor Vogel, MD, director of the Magee-Women’s
Hospital/University of Pittsburgh Cancer Institute Breast Program, recommended
obtaining software for the Gail or Claus assessment models or accessing the
National Cancer Institute’s assessment tool at http://bcra.nci.nih.gov/brc/.
For women who are at average risk, the group recommends an annual clinical
breast examination, annual mammography starting at age 40, and a reassessment
of risk every 2 to 3 years.
The elevated/high-risk group is comprised of women who have atypical ductal
or lobular hyperplasia or cellular atypia, a 5-year risk of 1.7% or more on the
Gail index, and/or two or more second-degree relatives who developed breast
cancer before menopause. Women who have used estrogen-progesterone replacement
therapy for 10 years or more are also in this group because of evidence that
this therapy increases risk by 5% for each year it is taken.