Usefulness of Gail Model Breast Cancer Risk Assessment Tool in the Indian Context – A Case Control Study

Background : Breast cancer is the commonest cancer among females in the state of Kerala, India. Gail et al. model is considered as a good tool to estimate woman's risk of developing breast cancer and are useful in targeting screening and prevention efforts.1 Objective : To determine the usefulness of Gail model Breast cancer risk assessment tool in identifying women at high risk for breast cancer in Kerala Methods : A case control Study was conducted at Regional Cancer Center Trivandrum by including all breast cancer patients admitted for surgery from 1stof September 2003 to 31stDecember 2004(Case n=660 and controls n=920). Participants were interviewed using a proforma. Gail’s tool was used to calculate risk. The participants were grouped as High, Normal or Low risk with regard to their risk in comparison with the general population score given in the calculator. Sensitivity and specificity of the model was found out. Unconditional logistic regression was used to estimate odds ratio 95% confidence intervals (C.Is) and for the final Model. Results : The Mean Score of cases was 0.872(SD 0.460) and that of Controls was 0.731(SD0.403).(t-5.392;Sig.000).Overall sensitivity is14.2 and specificity is 89.2. The major risk factors of breast cancer were age, irregular periods, previous history of breast biopsy, presence of first degree relatives with breast cancer, history of abortion, absence of live birth, late age at first live birth, post-menopausal status and absence of breast feeding. Breast feeding provides protection against Breast Cancer. Age of menarche was not found to be as a risk factor for breast cancer. A new model was also made using the identified risk factors. Conclusions : Gail Model cannot be used to predict high risk women in Kerala. A new model formulated based on the identified risk factors should be more useful in community wide screening programmes in Kerala. Keywords : Breast Cancer Risk, Gail Model, Case Control Study, Kerala