Risk Tools Limited in Their Ability to Predict Development of Breast Cancer including Editorial Comment

Article: 
....Major Limitations Exist
According to the researchers, these models each have major limitations. Most notable is that the models rely on known risk factors, given that up to 60% of breast cancers occur in the absence of known risk factors. In addition, with the exception of the Gail model, these tools have not been well validated, and they also do not include nonhereditary risk factors. However, even the Gail model has limited ability to discriminate between individuals at risk, especially those in higher-risk groups, according to the study authors.
To date, no existing model is "totally able to discriminate between families that do and do not have mutations or between women who will and will not develop breast cancer," they write. "Steady and incremental improvement in the models are being made, but these changes require revalidation."
Other risk factors, such as mammographic density, weight gain, and serum steroid hormone measurements, are being considered for inclusion in the existing models. Studies are underway to determine if these factors are feasible and will improve breast cancer risk prediction, according to the study authors.

Editorial: Models Differ in Details
"The authors have provided a useful survey of the literature and have presented an informative summary of the risk factors used in various models," write Mitchell Gail, MD, PhD, and Phuong Mai, MD, from the National Cancer Institute, in a related editorial. Drs. Gail and Phuong caution, however, that the various models differ in important details and that physicians need to be cognizant of these differences.
"Promising directions include incorporating mammographic density, information on genotype or regulation of gene expression ... and more refined use of pathology data and biomarker data from biopsy samples," the editorialists add.