Study: New tool to predict breast cancer risk for Black women
|At a glance||Conclusion|
|Study findings||Clinical trials|
|Strengths and limitations||Guidelines|
|What does this mean for me?||Questions for your doctor|
STUDY AT A GLANCE
What is this study about?
This study is about a breast cancer risk prediction tool designed specifically for Black women in the United States.
Why is this study important?
Breast cancer risk prediction tools are used to guide decisions on screening and prevention. Current risk prediction tools use various risk factors to estimate a person’s breast cancer risk and/or the likelihood that they have an inherited mutation that increases their risk. These tools do not estimate risk as well for Black women as they do for white women. Because Black women on average are diagnosed with breast cancer at earlier ages than white women and are more likely to be diagnosed with advanced disease, researchers wanted to develop a tool that can be used by Black women and their healthcare providers to better determine risk for developing breast cancer.
Separate tools are used to calculate the risk for having an inherited mutation, such as or . This research study did not look at the tools to predict the likelihood of someone having a mutation.
Data specifically collected from Black women in the United States were used to make and validate this tool. Over 3,000 Black women with breast cancer and 3,000 women without breast cancer (aged 30-69 years) were included in the development of this breast cancer risk prediction tool. The tool uses a woman’s personal medical and reproductive history and the history of breast cancer and cancer among her first-degree relatives (parents, siblings, children) to estimate her breast cancer risk.
The tool was tested using data from the Black Women’s Health Study. This is an ongoing study of almost 60,000 self-identified Black women in the U.S. The validation data set included just over 1,500 women with breast cancer.
- Among Black women, this new tool was more accurate than any other currently available risk prediction tool (e.g., those developed using data mostly from white women).
- The new tool worked best for Black women under age 40.
- All information needed for the tool was provided by the women themselves. No other test was needed.
The online risk calculator can be found here.
- The tool was derived and tested with data from Black women in the U.S.
- This tool works best for Black women under age 40.
- This tool works best for young Black women. While it can be used by older Black women, additional research may improve the tool’s ability to predict breast cancer risk for these women.
- While the tool asks about a woman’s personal and family history of breast cancer as well as her family history of cancer, it does not include her personal or familial history of ovarian, pancreatic and other cancers that are related to , , and other high-risk genes. Thus, it is likely that this tool will underestimate breast cancer risk in women with inherited mutations.
Your breast cancer risk may affect your medical options for screening and cancer prevention. This new tool allows more accurately predicts breast cancer risk for Black women in the U.S. If you are a Black woman (especially under age 40), you and your healthcare providers can use this tool to gain a better estimate of your cancer risk.
If your risk for breast cancer is high, you may be eligible for the following options:
- Beginning mammograms at an earlier age
- Additional screening with breast
- Tamoxifen, raloxifene or other medications to lower your risk
It’s important to note that although this tool improves breast cancer risk assessment in Black women, it’s one of several tools that can be used together to accurately assess overall cancer risk. Additional tools can be used to estimate the risk of having an inherited mutation linked to cancer. Women with a personal or family history of breast, ovarian, pancreatic or cancer should speak with their doctor for a referral for genetic counseling and testing. Experts have separate guidelines for women who test positive for an inherited mutation linked to breast cancer risk. The exact recommendations depend on which gene has a mutation.
This breast cancer risk prediction tool can be used by Black women in the U.S. who are ages 30-70 and their healthcare providers. This tool was better at predicting risk in Black women under age 40. This tool can help doctors better tailor breast cancer screening and prevention based on a person’s risk. By helping to identify Black women who are at higher than average risk, this tool may also help women make decisions about whether or not to participate in research studies on new ways to lower breast cancer risk. By providing more accurate information about risk, it is hoped that this tool can help reduce racial disparities in deaths due to breast cancer by offering women more precise information on which to base their medical decisions.
Palmer JR, Zirpoli G, Bertrand KA, et al., A Validated Risk Prediction Model for Breast Cancer in US Black Women. Journal of Clinical Oncology. 2021 Dec 1;39(34):3866-3877. Published online 2021 October 8, 2021.
Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board before publication to assure scientific integrity.
Photo by Eye for Ebony on Unsplash.
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This article is relevant for:
Black women in the U.S.
This article is also relevant for:
Healthy people with average cancer risk
People with a family history of cancer
Be part of XRAY:
The National Comprehensive Cancer Network (NCCN) establishes guidelines for women with increased risk (a lifetime risk for breast cancer of 20 percent or more). The guidelines recommend the following screening:
- Have clinical exams every 6–12 months, starting when you are identified as being at increased risk, but not before age 21.
- Consider consulting with a genetic counselor or similarly trained health care provider, if you haven’t already done so.
- Consider consulting with a breast surgeon.
- Start annual screening at age 40 or 10 years earlier than the age of the youngest family member who has been diagnosed with breast cancer, but not before age 30. Consider getting a 3-D .
- Begin annual breast at age 40 or 10 years earlier than the age of the youngest family member who has been diagnosed with breast cancer, but not before age 25.
- Consider recommended risk reduction strategies, such as preventive hormonal medications.
- Develop breast awareness and report any changes to your health care providers.
NCCN has separate guidelines for breast screening in women with an inherited mutation. See our gene-by-gene listing to find specific risk-management guidelines for people with an inherited mutation linked to cancer.
The National Comprehensive Cancer Network (NCCN) establishes guidelines for risk-reducing medication in women with increased risk for breast cancer based on risk-calculation tools. The NCCN recommends that high-risk women should have a discussion with their doctor about the benefits and risks of medications to lower breast cancer risk. These guidelines recommend:
- For women who choose to take risk-reducing medication:
- All women should undergo a gynecologic exam to check for uterine abnormalities before starting risk-reducing medications.
- Premenopausal women may be offered five years of Tamoxifen
- Postmenopausal women may be offered one of the following medications based on bone density, uterine abnormalities or other factors:
- five years of Tamoxifen
- five years of Raloxifene
- five years of an aromatase inhibitor
- Risk-reducing medication is strongly recommended for women with a personal history of atypical hyperplasia or Lobular Carcinoma in Situ ().
- Women who take risk-reducing medication need to continue regular breast screenings.
Clinical trials studying other agents to reduce breast cancer risk may be available.
Questions to ask your healthcare provider
- What is my lifetime risk of breast cancer?
- What is my risk of breast cancer over the next five years?
- Given my family history of cancer, should I have genetic counseling and testing?
- Given my breast cancer risk, when should I begin ?
- Given my breast cancer risk, should my screening include MRIs?
- Given my breast cancer risk, what are the benefits and risks of taking medication to prevent breast cancer?
The following are breast cancer screening or prevention studies enrolling people at high risk for breast cancer.
- NCT04711109: Denosumab for Preventing Breast Cancer in Women with a Inherited Mutation (BRCA-P). This study will test the effectiveness of a drug (denosumab) on preventing the development of breast cancer in women with an inherited mutation.
- NCT04067726: Denosumab and Mammographic Density in Premenopausal Women With Dense Breasts (TRIDENT). This study is looking at the drug denosumab to learn if it can reduce breast density in high-risk premenopausal women who have dense breasts.
- The Risk Factor Analysis of Hereditary Breast and Ovarian Cancer In Women with , or Mutations. This study seeks to improve researchers’ understanding of how hormonal, reproductive and lifestyle factors may be associated with cancer in high-risk people.
- NCT02620852: Women Informed to Screen Depending on Measures of Risk (WISDOM) study. The goal of this study is to determine if breast cancer screening can be made better by personalizing each woman’s schedule, compared to the current one-size-fits-all, annual approach.
- NCT03729115: A Multi-Modality Surveillance Program for Women at High Risk for Breast Cancer is a clinical trial at the University of Chicago that is enrolling women age 21 and older who are , , , or carriers for an and anxiety reduction trial.
Additional risk-management clinical trials for people at high risk for breast cancer may be found here.
Who covered this study?
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