Skip to main content
Hamburger Menu Close
Advertisement

Women

Breast cancer risk assessment tools: What to know, what they don’t tell you, and what works for early detection

Breast cancer risk assessment tools estimate a woman’s chance of developing breast cancer. However, they’re not without flaws. Experts in Singapore explain that even if these tools were perfect, they would still not tackle the main reasons women are diagnosed late.

Breast cancer risk assessment tools: What to know, what they don’t tell you, and what works for early detection

When it comes to managing breast cancer, early detection is key. (Photo: iStock/PonyWang)

New: You can now listen to articles.

This audio is generated by an AI tool.

Earlier this year, American actress Olivia Munn revealed that she had been diagnosed with breast cancer and had undergone a double mastectomy. The thing that saved her life? A breast cancer risk calculator. 

The  44-year-old actress’ obstetrician-gynaecologist had calculated her breast cancer risk assessment score, which found she was in the high-risk group. This prompted Munn to get a magnetic resonance imaging (MRI) scan, a breast ultrasound, and finally, a biopsy that showed she had Luminal B cancer in both breasts. 

She then urged all women to ask their doctors to calculate their breast cancer risk assessment score as it could save their lives, too. 

HOW A BREAST CANCER RISK ASSESSMENT CALCULATOR WORKS

A breast cancer risk assessment calculator is a tool to detect breast cancer early. Used by healthcare professionals, it estimates a woman’s likelihood of developing breast cancer over time. 

Two widely used calculators in the United States are the Breast Cancer Risk Assessment Tool, also known as the Gail model, and the Tyrer-Cuzick Risk Assessment Calculator, also called the IBIS model, which Munn used. 

Both are free online calculators. They ask users their age, race, ethnicity, family history of breast cancer, when they first started their periods, and, if they have children, how old the women were when they had their first child. 

Although men can also develop breast cancer, the tools calculate risk for women only. And while any woman could fill in the questionnaire, the tools are validated only for women living in the United States, who are white American, black American, Hispanic, Asian and Pacific Islander.

The calculators compare a woman’s answers with the average for other women from the same age and racial group and use that to estimate the five-year and lifetime risk of developing breast cancer.

APPLYING THE BREAST CANCER RISK ASSESSMENT TOOL IN SINGAPORE

Early detection and management of breast cancer depend a lot on cultural and social factors. (Photo: iStock/simon2579)

Will the breast cancer risk assessment tool work well in Singapore? In short, not really. 

First, there’s the issue of applicability.

Dr Andrew Clayton Lee, a general surgeon and oncoplastic breast surgeon at Gleneagles Hospital, explained that these breast cancer risk calculators are designed based on data from North American women. The demographics of Singapore women, consisting mostly of Southeast Asian Malays, Indians, and Chinese, are unlikely to be accurately represented in these models.

“If women in Singapore were to take the test, results can be inaccurate,” Dr Lee said. “We don’t want women with high risks to have a false sense of security, or cause worry for those with low risks.”

Second, health checks need professional guidance.

Dr Choo Bok Ai, a senior radiation oncologist at Icon Cancer Centre and a Breast Cancer Foundation committee member, told CNA Women that due to their easy access, breast cancer risk calculators are often used in isolation without the involvement of a healthcare professional. Women may misinterpret the results, particularly if they receive a high-risk score. 

They may avoid getting proper medical consultation or opt for alternative care that doesn’t address the actual health concern. This could result in unnecessary fear or even misdiagnosis or mistreatment of existing conditions.

While some women may see their doctor to review the results, Dr Choo said the concern is for those who don’t.

Third, the tool does not solve the underlying reasons why women in Singapore hesitate to go for breast checkups.

“Prevention and education are more important than assessment tools when it comes to early detection and management of breast cancer,” Dr Choo said.

He pointed out that the primary challenge in reducing late-stage breast cancer diagnoses is the lack of education and awareness. Some women are deterred by cultural taboos surrounding discussions about breast health, the fear of diagnosis, social ostracisation, and misconceptions about cancer. 

Dr Choo referred to the 2022 National Population Health Survey, where roughly 40 per cent of Singapore women aged 50 to 69 get regular mammograms. CNA Women found that in 2023, mammogram screening rates for the same age group have dropped, to below 35 per cent. 

Societal barriers, including caregiving responsibilities and financial constraints, further discourage women from prioritising regular screenings like mammograms or seeking medical help when they discover a lump or notice irregularities. 

EXISTING TOOLS FOR EARLY DETECTION OF BREAST CANCER MAY NOT BE ENOUGH

Breast cancer can be detected early through mammograms, breast ultrasounds, and monthly breast self-examination. (Photo: iStock/spukkato)

In Singapore, these methods are available for early detection of breast cancer:

  • Mammograms, which use low-dose X-rays to identify irregularities such as small white spots, lumps or tumours. These are recommended annually for women aged 40 to 49, and once every two years for women above 50.
  • Breast ultrasounds, which is a non-invasive method of using sound waves to detect abnormalities. These are usually recommended as a supplement to mammograms for women with denser breasts.
  • Breast MRIs, typically reserved for women at higher risk or when further investigation is needed after other screenings.
  • Breast self-examinations, which should be done monthly by women aged 20 years and above, seven to 10 days after the start of their period. 
Prevention and education are more important than assessment tools when it comes to early detection and management of breast cancer.

Dr Lee noted that more clinics in Singapore are offering 3D mammograms. While they cost more, 3D mammograms provide clearer images and are more effective in detecting potential issues compared with the standard 2D mammogram. 

However, Dr Lee added there are limitations to current methods of detecting breast cancer. 

Mammograms, for example, are not foolproof, particularly for younger women or those with dense breast tissue. He said: “Mammograms may not pick up all early signs of breast cancer in these cases, and false negatives can occur.”

Munn is an example of this. She revealed on Instagram that a mammogram she did a few months before her breast cancer diagnosis showed no abnormalities. She also tested negative for 90 different cancer-related genes, including BRCA1 and BRCA2, which are linked to breast cancer.

In addition,  the accuracy of ultrasounds relies on the skills of the sonographer or radiographer, said Dr Lee. While rare, there are instances where a significant cancer indicator, such as lesions, may be overlooked.

Similarly, the effectiveness of self-examinations relies on a woman’s knowledge and familiarity with her breasts. Without knowing what to look for, such as dimples or lumps, important abnormalities may go unnoticed.

It’s why early detection and prevention go hand in hand when it comes to battling cancer, Dr Choo explained. 

While calculators like the Gail and IBIS models may not be as useful in Singapore, Dr Lee said that genetic risk assessments, which use blood or saliva samples to look for genetic changes linked to a higher risk of breast cancer, are available. 

Dr Choo added that genetic testing is recommended for women with close female relatives, such as their mother or sister, who have had breast cancer. 

Although factors like family history are beyond our control, women can still take steps to reduce their cancer risk through lifestyle changes. 

Since 80 per cent of cancer risk is linked to lifestyle, Dr Choo recommended eating a balanced diet, exercising regularly, managing stress, and reducing alcohol consumption as some of the most effective ways to lower one’s cancer risk. 

“These are the more pressing and effective ways to fight cancer early, more so than breast cancer risk calculators,” he said. 

CNA Women is a section on CNA Lifestyle that seeks to inform, empower and inspire the modern woman. If you have women-related news, issues and ideas to share with us, email CNAWomen [at] mediacorp.com.sg.

Source: CNA/iz
Advertisement

RECOMMENDED

Advertisement