Evaluating the Gail Model: Racial Disparities in Breast Cancer Risk Assessment

Area of Science:

• Medical informatics
• Public health
• Epidemiology

Background:

• The Gail Model, a breast cancer risk assessment tool, was initially developed on data from predominantly White women.
• Despite recalibrations with diverse populations, concerns persist about underestimating breast cancer risk in certain racial groups.

Purpose of the Study:

• To evaluate the performance of the Gail Model in classifying breast cancer risk across different racial groups.
• To identify potential racial disparities in high-risk (HR) classification.

Main Methods:

• A retrospective study analyzed electronic medical records of 31,256 women aged 25-75 who underwent mammograms.
• The cohort comprised diverse racial groups: 11,589 Black/African American, 11,008 White, 5,872 Hispanic/Latino, 1,429 Asian, and 1,358 other.

Main Results:

• Significant differences in high-risk (HR) classification were observed across racial groups.
• White women had the highest HR classification rate (11.4%).
• Black women had a significantly lower odds ratio (OR = 0.23) for HR classification compared to White women, even after controlling for other variables. Breast cancer diagnosis rates were similar between Black (1.57%) and White (1.6%) women.

Conclusions:

• The Gail Model demonstrates racial disparity in high-risk classification.
• Black women are less likely to be identified as high-risk, despite comparable cancer incidence rates to White women.
• This highlights potential limitations of race-based variables in risk assessment algorithms.