How a Breast Cancer Risk Assessment Tool Is Aiding Early Detection
- “X-Men” actress Olivia Munn, 44, is grateful countless women are using her breast cancer journey to empower their own by getting the breast cancer risk assessment.
- Munn was diagnosed with breast cancer despite a “normal” mammogram and testing negative for the BRCA gene mutation, which elevates your risk for breast and ovarian cancer. At the request of her OBGYN, Munn underwent a Breast Cancer Risk Assessment, which led to the discovery of her cancer after additional screening.
- Breast Cancer Risk Assessment is a “statistical model that allows healthcare professionals to calculate the probability of a woman developing breast cancer throughout their lifetime,” Dr. Ruth Oratz, breast medical oncologist at NYU Langone, tells SurvivorNet. It assesses a woman’s age, family history with breast cancer when she first had a menstrual period, and her reproductive history to determine her risk of breast cancer.
- The National Cancer Institute’s Breast Cancer Risk Assessment Tool calculator estimates a woman’s likelihood of developing invasive breast cancer based on her medical, reproductive, and family history. However, it cannot accurately assess risk for those with BRCA gene mutations, a history of breast cancer, or prior radiation for Hodgkin lymphoma.
- Munn underwent a double mastectomy, which removed both breasts and eliminated the cancer. If a woman opts to have reconstructive surgery after the mastectomy, surgeons either use an implant or take tissue from elsewhere on the body.
The Breast Cancer Risk Assessment Tool, also called the Gail Model, allows doctors to estimate a woman’s risk of developing invasive breast cancer over the next five years.
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“Every time I go out, there’s at least one person…there was this woman who’s young. She has three kids, and she says because of my story, she went out and took the test and learned she has stage 0 breast cancer,” Munn explained in an Instagram story.
“We both had this moment, I know what you’re going through, but we’re so excited that you found it early,” Munn continued.
“It’s hard to explain knowing that this diagnosis that put so much fear into me has been able to be turned into something that’s saving people’s lives,” Munn told “Meet the Press” host Kristen Welker.
Since Munn shared her story publicly, the National Cancer Institute attributes an uptick in women inquiring about a cancer risk assessment to the “X-Men” actress.
“That makes me really emotional when I think about that because, like, that was my goal, was for every woman to know about this test. That women are finding out about this and it’s saving their lives is just, it’s hard to explain. It’s hard to explain knowing that this diagnosis that put so much fear into me has been able to be turned into something that’s saving people’s lives. And that’s all I wanted,” Munn said emotionally.
Helping Patients Cope with a Breast Cancer Diagnosis
How Munn Was Introduced to the Breast Cancer Risk Assessment
“I wouldn’t have found my cancer for another year – at my next scheduled mammogram – except that my OBGYN…decided to calculate my Breast Cancer Risk Assessment Score. The fact that she did save my life,” Munn said in an Instagram post.
The Breast Cancer Risk Assessment she credits for catching her breast cancer is a “statistical model that allows healthcare professionals to calculate the probability of a woman developing breast cancer over the course of their lifetime,” Dr. Ruth Oratz, breast medical oncologist, NYU Langone Health’s Perlmutter Cancer Center; clinical professor of medicine, NYU Grossman School of Medicine tells SurvivorNet.
Last year, she wanted to be proactive about her health and underwent genetic testing.
Genetic tests can be as simple as a simple saliva swab or blood sample. The results help your care team determine if you have a specific mutation that puts you at higher risk for cancer. The results help doctors tailor your treatment and are helpful for breast cancer patients.
“I tested negative for all (different cancer genes), including BRCA,” Munn said.
The BRCA1 and BRCA2 gene mutations are among the most important genes to look for in breast cancer. Together, they are responsible for about half of all hereditary breast cancers. These genes prevent cells from dividing haphazardly and uncontrollably in a person without mutations. Mutations prevent these genes from doing their job and can allow unchecked growth of breast, ovarian, and other tissues.
However, two months after undergoing genetic testing, Munn was diagnosed with Luminal B breast cancer in both of her breasts.
According to research in “Breast Cancer,” luminal B tumors are of a “higher grade” and tend to have a worse prognosis. This type of breast cancer is estrogen-positive (ER), meaning the hormone estrogen fuels it. It can also be progestogen (PR) negative, meaning it is not fueled by progestogen. This type of breast also tends to have a higher expression of the Ki67 protein, making it grow quickly. Hormonal therapy and chemotherapy are often used to treat this type of cancer.
Luminal is one of several types and is distinguished by its molecular makeup. Other types of breast cancer types include:
- Luminal A breast cancer
- Luminal B breast cancer
- Luminal B-like breast cancer
- HER2-enriched breast cancer
- Triple-negative or basal-like breast cancer
Each type has a specific, individualized molecular structure. The different types of the molecular structure of breast cancer may inform the treatment path.
Understanding Your Breast Cancer Risk
The Breast Cancer Risk Assessment examined Munn’s age, family history with breast cancer when she first had a menstrual period, and her reproductive history to determine her risk of breast cancer.
Dr. Oratz says if the Breast Cancer Risk Assessment finds that a woman is at higher risk of getting breast cancer, she should expect further testing and screening. However, if a woman is positive for the BRCA gene mutation, a Breast Cancer Risk Assessment “is not really accurate.”
“Having information empowers patients. It is very important for people to be aware of the health risks, their family history, and their own personal medical conditions. All of these things can affect the risk of developing cancer,” Dr. Oratz tells SurvivorNet.
“I’m lucky. We caught it with enough time, and I had options. I want the same for any woman who might have to face this one day. Ask your doctor to calculate your Breast Cancer Risk Assessment Score. Dr. Aliabadi (Munn’s OBGYN) says that if the number is greater than 20%, you need annual mammograms and breast MRIs starting at age 30,” Munn said.
Munn’s Breast Cancer Risk Assessment score was at 37%, which led to her undergoing an MRI, ultrasound, and a biopsy, which confirmed her breast cancer.
The National Cancer Institute has an online calculator that helps women understand their cancer risk. The Breast Cancer Risk Assessment Tool, “uses a woman’s personal medical and reproductive history and the history of breast cancer among her first-degree relatives (mother, sisters, daughters) to estimate the absolute breast cancer risk-her chance or probability of developing invasive breast cancer in a defined age interval.”
The Breast Cancer Risk Assessment Tool calculator cannot accurately assess breast cancer risk for women carrying the BRCA gene mutation, who have received radiation for Hodgkin lymphoma, and who have a history of invasive or in situ breast cancer.
Munn’s Breast Cancer Surgery and Continued Treatment
Munn underwent a double mastectomy to treat her cancer.
When a woman decides to have a mastectomy, several factors go into that decision. Among things to consider is whether to have breast-conserving surgery such as a lumpectomy. These decisions should be made alongside your doctor by openly and candidly discussing risks vs. benefits.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removing of the tissue,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet. “The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
WATCH: What Happens During a Double Mastectomy
Other factors that weigh into the decision to get a mastectomy are the size and features of the tumor and your family history. However, the gravity of your decision comes into full view, especially if you choose to get a mastectomy and remove both of your breasts.
Some women decide to have their breasts reconstructed and have implants put in right after the mastectomy, while others don’t have reconstruction at all.
Dr. Port added that most women opt to have some reconstruction. The length of these surgeries can vary greatly. When implants are used, the procedure can take two to three hours (so the total surgery time would be around five hours). There is also the option to take one’s own tissue (usually from the belly area) and transfer it into the breast area during reconstruction.
What To Ask Your Doctor
If you have been diagnosed with breast cancer, you may have questions about keeping your strength through treatment. Here are a few questions to help you begin the conversation with your doctor:
- What treatment will I be receiving?
- What side effects are associated with this treatment?
- Are there steps I can take daily to help minimize these side effects?
- What physical activity routine do you recommend for me during treatment?
- Do you have recommendations for someone who doesn’t particularly enjoy exercise?
- Can you recommend a dietician who can help me with healthy eating tips and weight maintenance?
- I’ve been having trouble sleeping. Do you have any treatment recommendations?
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