Breast cancer risk assessment in indigent women at a public hospital

The aims of this study were to estimate the 5-year breast cancer risk in indigent women presenting to the gynecology clinic at a public hospital and to determine whether routine use of the computerized Gail model for screening in this population identifies individuals at increased risk.

A prospective study was performed over 1-year period (7/99-7/00) of women presenting to the gynecology and gynecologic oncology clinics at a public hospital. All women ages 35-60 years with no personal history of breast cancer were offered testing utilizing the computerized Gail model provided by the National Cancer Institute. Age, race, age at menarche, age at first live birth, number of first-degree relatives with breast cancer, number of breast biopsies, and number of breast biopsies diagnosed as atypical hyperplasia were documented. A calculated 5-year risk > or =1.67% was considered high-risk.

In all, 319 women enrolled, 121 (38%) with a history of gynecologic cancer and 198 (62%) without. The mean age was 46.9 years (range 35-60), and 28 (8.8%) patients had at least one first-degree relative with breast cancer. Ethnicity included 206 (65%) African American, 52 (16%) Caucasian, 45 (14%) Hispanic, and 16 (5%) oriental. Eight (2.5%) women had a 5-year risk > or =1.67%. The mean 5-year risk for all patients was 0.68% (0.55% for African American versus 0.90% for Caucasian/other, P < 0.001).

Estimating 5-year breast cancer risk using the Gail model in indigent women may identify individuals at increased risk. Compared to other patients, African American women appeared to have a lower estimated 5-year risk according to the currently available model. The routine utilization of the Gail model deserves further investigation in the indigent minority population.