KOCHI: For long, the Gail model to detect the risk of breast cancer was considered reliable for all women until doctor duo Dr Regi Jose, professor of community medicine at Sree Gokulam Medical College and medical director of Snehita Women’s Health Foundation and her husband Dr Paul Augustine, head division of Surgical Oncology, Regional Cancer Centre, Thiruvananthapuram, found otherwise. The duo devised a risk calculator after a thorough research, which showed that the model was less effective for women in Kerala and that primary factors included previous breast biopsies and the number of first-degree relatives with breast cancer.
“We initiated the project in 2003. My husband did his NCI fellowship in breast diseases at Washington Hospital Centre and Memorial Sloan Kettering in the US in 2001, which shed light on the usage of a risk calculator to detect the chances of breast cancer. Back then, it was primarily used to select people for mammography scans which was conducted community-wide. The same isn’t cost-effective here and is simultaneously dangerous. Such a community-wide approach isn’t feasible either. Therefore, we decided to test the Gail model to detect women in the high-risk category,” said Reji.
The Gail risk assessment model has five major variables. “People are likely to forget these five specific factors; recall bias has always been a problem in case control studies. In our model, we assumed there wouldn’t be such a bias as the variables are basic. The study was conducted between 2003 and 2005 among women at the RCC and Thiruvananthapuram corporation limits. The sample size included women 660 with and 920 women without a prior history of breast cancer. This sample was considered as the representative sample of the Kerala population,” explained Regi.
The A-J Model
Upon realising that the Gail model wouldn’t be an accurate one for Keralites, the doctors created a logistic regression equation and employed seven parameters such as current age, age at menarche, age at first live birth, number of live births, history of breastfeeding, number of first degree relatives with breast cancer and the total number of previous breast biopsies. The score one receives says the probability of breast cancer in comparison with the risk of the general population.
This helps to determine the type and frequency of screening required. “The risk calculator can be accessed on snehita.in/risk. Scores below 0.5 indicate low-risk, numbers between 0.5 and 0.75 is moderate risk and anything higher than 0.75 reveals that one is at high-risk,” she said. The calculator also comprises guidelines on what must be done. While one must always consult a physician for diagnosis, the calculator is an awareness and motivational tool, Regi added.
Technical Team
Dr Anoop Lal, Sreekanth Sudarsanan, Sindhu Chendurpandian, and Chitra G Nair formulated the online tool and incorporated it on the website. Check yourself on the link snehita.in/risk.