Breast Cancer Risk Assessment

April 10, 2025

This page was reviewed under our medical and editorial policy by Leah Naghi, M.D., assistant clinical professor, and Susan Yost, Ph.D., staff scientist, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte

A breast cancer risk assessment helps patients and their care teams gauge the likelihood of getting breast cancer in the future. By taking into account a combination of factors, such as family history, personal health and lifestyle choices, these assessments help patients know if they are at average or increased risk for developing breast cancer.

This information is important for planning screening tests and thinking about potential ways for patients to reduce their risk. For some patients, a higher risk might mean more frequent checkups, genetic counseling or advanced imaging tests like a breast magnetic resonance imaging (MRI) test.

Several tools are available to help guide these decisions.

How a Risk Assessment for Breast Cancer Works

A breast cancer risk assessment tool asks patients about key risk factors that might impact their chance of developing the disease. Several risk assessment tools are available. A risk factor increases the chance of getting a disease, like breast cancer, but having one or even several risk factors does not mean a person will definitely develop it.

Drinking alcohol, being overweight or obese, and not being physically active may all increase breast cancer risk. Not having children, not breastfeeding or using hormonal birth control or menopausal hormone therapy also play a role.

Additional risk factors include age, gender and inheriting certain gene changes, such as BRCA1 or BRCA2 mutations. Family history is another important factor — having close relatives with breast cancer may increase risk. Additionally, dense breast tissue or certain noncancerous breast conditions may elevate risk. Race and ethnicity may also play a role, with some groups being more susceptible than others. 

Health care providers gather information about these factors during a risk assessment. This helps the care team tailor breast cancer prevention and screening to each person’s needs.

What Are the Breast Cancer Risk Assessment Tools?

Different health care providers may use various tools to assess breast cancer risk. Some of the tools include more factors than others, and some address breast cancer risk more specifically in certain groups, like Black women. All are designed to help give patients a measure of their level of risk.

While the tools may vary, the major ones that guide these assessments are widely recognized and used in clinical practice.

The Gail Model

The Gail Model, also known as the Breast Cancer Risk Assessment Tool (BCRAT), helps estimate a woman’s risk for developing invasive breast cancer over specific periods, such as the next five years or up to age 90.

This tool uses personal information, including age, age at menstruation, age at first childbirth and family history of breast cancer in close relatives like a mother or sisters. It also considers the number of previous breast biopsies and whether abnormally shaped cells were found in those biopsies.

The Gail Model is widely used and has been studied and validated for different racial and ethnic groups in the United States. However, it may underestimate the risk for Black women with prior biopsies and Hispanic women born outside the United States. Additionally, it is not designed for women with BRCA gene mutations or those with a history of breast cancer. The assessment takes about five minutes to complete.

The Tyrer-Cuzick Risk Assessment Calculator

The Tyrer-Cuzick breast cancer risk assessment, also known as the IBIS model, is another tool for guiding breast cancer screening and prevention. It has been used by organizations such as the National Comprehensive Cancer Network and the American Cancer Society.

This model considers a variety of personal factors, including weight, height, age at first menstruation, first childbirth and menopause, as well as any use of menopausal hormone therapy. It also looks at family history of breast or ovarian cancer.

While the Tyrer Cuzick test is an appropriate tool for many groups, it may overestimate risk in Hispanic women.

The Breast Cancer Surveillance Consortium’s Risk Calculator

The Breast Cancer Surveillance Consortium (BCSC) risk assessment model estimates a woman’s five- and 10-year risk for developing invasive breast cancer.

Unlike other models, the BCSC model includes breast density, a key factor that increases its accuracy. It also considers age, race or ethnicity, family history of breast cancer and history of breast biopsies. While it is generally considered accurate, it may underestimate risk in younger women and those with low breast density.

This model is unique in including the breast density measure, making it a valuable tool for assessing breast cancer risk across different racial and ethnic groups, particularly in average-risk women.

The Black Women’s Health Study Breast Cancer Risk Calculator

The Black Women’s Health Study assessment is a tool specifically designed to predict breast cancer risk in Black women.

This model was developed using data from more than 3,000 Black women with breast cancer and has shown better accuracy for this group compared to other models. It is particularly appropriate for younger women under 40.

The model looks at factors like family history of breast cancer, history of breast biopsies, long-term use of oral contraceptives, age at first menstruation and breastfeeding history. This tailored approach helps identify women at higher risk for early detection and preventive care.

Breast Cancer Risk Score Results

Breast cancer risk score results estimate how likely a person is to develop breast cancer, but they are not guaranteed predictions. These scores rely on population averages, assessing risk by comparing factors like age and family history.

For instance, a 5% risk score means that out of 100 women with similar factors, five might develop breast cancer. However, this does not guarantee that a person with a high score will get cancer, nor does a low score mean they will not.

After receiving risk scores, patients should discuss the results with their doctors. If the score indicates a higher risk, the doctor may suggest more frequent screenings, such as mammograms or advanced imaging techniques. Genetic counseling might also be recommended to explore inherited risks, and preventive measures like medications or surgery may be considered.

For those with an average risk, adopting healthy lifestyle choices — including regular physical activity, maintaining a healthy weight and limiting alcohol — may still help lower the chances of developing breast cancer.

These assessments are just one piece of understanding breast cancer risk. Doctors are able to interpret the results and guide patients on next steps for monitoring and reducing risk, whether that involves additional testing, preventive strategies or regular monitoring.