FNA and Gail model

nance

FNA and Gail model

nance

Hi, I was lucky enough to get a FNA for an area I thouhgt was troubling.(Two docs felt it was just glanular?). Anyway was B9. How will this effect my risk accordig to the Gail Model? Area was not seen on mammo or US. 

otter

nance,

I wondered the same thing last year, since the only type of biopsy I'd ever had was a FNA and it came back "benign" (the lump was a cyst).  A FNA counts as a biopsy when calculating risk with the Gail Model.  Here's the website for the Gail Model calculator, for those who haven't seen it:

 http://www.cancer.gov/bcrisktool/

Here's the question about biopsies in the Gail Model:

Question 6:
Has the woman ever had a breast biopsy?
6a: How many previous breast biopsies (positive or negative) has the woman had?
6b: Has the woman had at least one breast biopsy with atypical hyperplasia?

 

Here's how "biopsy" is defined:

biopsy (BY-op-see)

The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. When only a sample of tissue is removed, the procedure is called an incisional biopsy. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When a sample of tissue or fluid is removed with a needle, the procedure is called a needle biopsy, core biopsy, or fine-needle aspiration.

I was confused, because both of my FNA's were done to check lumps that turned out to be cysts.  In one case, my GYN aspirated the cyst specifically so that it would not appear on my upcoming mammogram.  So, why would those "benign" FNA's increase my risk of BC?  I emailed the contact address to get more information, and they gave me this explanation, which is also on the Gail Model web page:

Explanation
Women who have had breast biopsies have an increased risk of breast cancer, especially if their biopsy specimens showed atypical hyperplasia. Women who have a history of breast biopsies are at increased risk because of whatever breast changes prompted the biopsies. Breast biopsies themselves do not cause cancer.

I was not happy with that answer, because it did not make sense to me.  Why would the presence of benign cysts in a woman in her late 30's or early 40's increase her risk of BC?  There is evidence that "dense" breast tissue is associated with an increased risk of BC, so maybe that's related to the FNA issue.

otter 

Marian61627

I agree  otter, since women have benigh cysts go in and out of their breast all the time!  It seems they hit you twice with the age thing if someone else (radiologist, bs etc) makes a miscalculation by ordering a biopsy??

Marian

leaf

You may be interested in this editorial about the modified Gail model. The Gail model pretty accurately predicts how many women in a population that has your characteristics will get breast cancer, but it does NOT do a good job at predicting YOUR chances of getting breast cancer, as an individual.


This was in a professional journal.



" Decarli et al. also assessed each model’s performance at the
level of the individual woman. A model that discriminates well at
this level should consistently predict a higher risk of breast can-
cer for women who will be diagnosed with the disease than for
women who will not. Decarli et al. randomly selected pairs of
women, one of whom was diagnosed with breast cancer and one
of whom was not, to determine the frequency with which each
model calculated a higher risk for the woman who developed
breast cancer. The resulting calculation produced a concordance
statistic, whose value could range from 0.50 (equivalent to a coin
toss) to 1.0 (perfect discrimination). The concordance statistics
for the Italian and Gail models were essentially the same, ap-
proximately 0.59 (with 95% confi dence intervals that ranged
from 0.54 to 0.63). In other words, for 59% of the randomly se-
lected pairs of women, the risk estimated for the woman who was
diagnosed with breast cancer was higher than the risk estimated
for the woman who was not. Unfortunately, for 41% of the pairs
of women, the woman with breast cancer received a lower risk
estimate than her cancer-free counterpart. Thus, for any given
woman, the two models were better at prediction than a coin
toss — but not by much. "

http://jnci.oxfordjournals.org/cgi/reprint/98/23/1673.pdf



"Although a woman's risk may be accurately estimated, these predictions do not allow one to say precisely which woman will develop breast cancer. In fact, the distribution of risk estimates for women who develop breast cancer overlaps the estimates of risk for women who do not."

http://www.cancer.gov/bcrisktool/about-tool.aspx

Note:if you look at the editorial, it gives you diagrams which show how much they overlap, which is, in this case, almost totally.


So, as the editorial of the professional journal says, its not worth a whole lot in predicting if YOU will get breast cancer.

Anonymous

otter---I think they include even the number of benign biopsies into the overall risk because even  some totally benign conditions (such as fibrocystic disease) can increase your risk, however slightly. Once you have atypia found (either ADH or ALH), your overall risk goes up significantly.

roseg

While the model uses those criteria I think that you might personally discount your biopsy since it wasn't generated by a mammogram/us/physical exam.

It sounds like you had the FNA because you were worried about something that your physicians weren't quite ready to biopsy. There isn't a thing wrong with that, but if you wanted to personally remove it from your risk factors when considering the Gail model I think you could.