Today, there's no clear solution. Some healthcare providers and organizations recommend annual screening for women starting at 40, and others recommend screening every other year starting at 50. Wait until women turn 50 to start screening, and you'll reduce the number of false alarms— but you'll also miss some cases of cancer. Screen every other year, and you face the same risks. So what's the answer?

Part of the answer is that every woman is unique. We have different risk factors, different genetic makeups, different family histories. Identifying high-risk patients will result in even better patient care. Working in concert with the patients' primary care providers, radiologists can identify and recommend increased surveillance for those patients who are at high risk.

SMIL Imaging centers are using MRS (Mammography Reporting Systems) to provide the underlying technology. By capturing individualized risk data in real time, healthcare providers can make impactful decisions about each individual's health care, rather than using broad assumptions to provide generalized care. That's what the whole precision medicine idea is about: tailoring the approach for each individual.

MRS is the leading provider of breast procedure information systems in the United States and the most widely used breast procedure reporting and tracking system in the world.

MRS software includes the ability to alert healthcare professionals when a patient's personal or family history indicates they may be at higher risk for breast cancer, consistent with professional society guidelines.

The Tyrer Cuzick 10 Year and Tyrer Cuzick Lifetime models utilize the following factors:

• Patient must be female.
• Patient's age.
• Patient's ethnicity.
• Patient's age at menarche.
• Patient's age at first full-term pregnancy.
• Patient's height .
• Patient's weight.
• History or lack of history of hyperplasia.
• History of LCIS.
• Patient's hormone history.
• History of ovarian cancer.
• Patient's family history of cancer.
• Patient's family history of genetic testing.

No calculations will be generated for the following reasons:

• Patient is male.

The Myriad BRCA Prevalence Table is a risk model that has been provided by Myriad Genetics, Inc. -the organization which patented the BRCA gene mutation test.

It provides the prevalence of BRCA1 and BRCA2 mutations based on:

• Presence or absence of a personal history of breast and/or ovarian cancer
• Presence or absence of a family history of breast and/or ovarian cancer

The Myriad Table utilizes the following Personal Cancer History:

• No breast cancer or ovarian cancer at any age
• Breast Cancer at or over age 50
• Breast Cancer under age 50
• Male breast cancer
• Ovarian cancer at any age, no breast cancer
• Breast Cancer at or over age 50 and ovarian cancer at any age
• Breast Cancer under age 50 and ovarian cancer at any age

And the following Family Cancer History:

• No breast cancer under age 50 or ovarian cancer at any age in any relative
• Breast Cancer in one relative under age 50, no ovarian cancer in any relative
• Breast Cancer in more than one relative under age 50, no ovarian cancer in any relative
• Ovarian cancer at any age in one relative, no breast cancer under age 50 in any relative
• Ovarian cancer at any age in more than one relative, no breast cancer under age 50 in any relative
• Breast Cancer under age 50 and ovarian cancer at any age

BRCA Risk Calculator and Mutation Prevalence Tables: http://www.myriadtests.com/app/provider/brca-mutation-prevalence.htm

The Gail 5 Year & NCI Lifetime Models utilize the following factors:

• Patient must be female.
• Patient's age must be between 35 and 85.
• Patient's ethnicity.
• Patient's age at menarche.
• Patient's age at first full-term pregnancy.
• Number of first degree relatives who have had breast cancer.
• Patient's biopsy history or lack of history.

No calculations will be generated for the following reasons:

• Patient is Male.
• Patient has previous diagnosis of LCIS.
• Patient has previous diagnosis of DCIS.
• Patient is younger than 35 or older than 85.
• Patient has previous history of breast cancer.

There are multiple breast cancer risk models but none are perfect. Each uses different groups of presumed breast cancer risk factors to make an estimate and results may vary from model to model due to differences in the factors taken in to account. The factors fall in three basic categories: hereditary, hormonal, and pathologic. The risk of breast cancer over time can help provide guidance for different management plans such as earlier (or later) mammography, risk-based screening, adding MRI, or the need for chemoprevention. The risk of mutation can help determine the need for genetic testing.

Because most of the studies showing the benefits of breast MRI have been based on screening women at high risk due to family history and/or genetic mutations, both the ACS and ACR recommend annual breast MRI in conjunction with annual mammography for women with a lifetime risk of breast cancer of 20-25% or greater using a model based mainly on family history such as Tyrer Cuzick.

http://m.cancer.org/healthy/informationforhealthcareprofessionals/acsguidelines/breastcancerscreeningguidelines/index

MRS - WHICH RISK MODEL IS IT?

Tyrer Cuzick Risk Assessment Model