The Value of Tyrer-Cuzick Versus Gail Risk Modeling in Predicting Benefit from Screening MRI in Breast Cancer

Breast cancer is the most commonly diagnosed malignancy in US women. Risk assessment tools such as the Gail and Tyrer-Cuzick (TC) models calculate risk for breast cancer based on modifiable and non-modifiable factors in order to guide screening and prevention for high-risk patients. Screening with magnetic resonance imaging (MRI) in addition to mammography is recommended in high-risk patients (>20% lifetime risk on TC or other familial based models). Currently, no published data indicate these recommendations improve cancer detection.

With the aim to determine what percentage lifetime risk (LR%) is associated with a statistically significant increase in cancer detection, the Virginia Commonwealth University (VCU) breast imaging database was reviewed to identify patients who received screening MRI.

The receiver operating characteristics (ROC) curves for the Gail and TC models and the rate of cancer detection correlated to 20% LR% were calculated. The Gail model was considered the control model as it is NOT considered a validated screening tool for MRI. TC is not more accurate than Gail when predicting benefit of breast MRI screening. (area under the curve (AUC): 0.6841, 0.6543 respectively, p = 0.828). Univariate analysis failed to demonstrate a statistically significant relationship between the Gail or TC LR % and diagnosis of breast cancer when using 20% as the cutoff for high-risk classification (p = 1.0, 0.369 respectively). Neither the TC nor the Gail risk calculators demonstrated a significant correlation between risk and the likelihood of diagnosis of breast cancer when screened with MRI.

Larger cohort studies are necessary to determine the risk percentage most predictive of a breast cancer diagnosis using MRI as screening.