The Gail model has been used to predict invasive breast cancer risk in women using the following risk factors: age, age at menarche, age at first live birth, number of first degree relatives with breast cancer, and number of previous benign breast biopsy examinations. However, this model underestimates breast cancer risk in black women. The Contraceptive and Reproductive Experience (CARE) model has been developed to replace the Gail model in predicting breast cancer risk in black women. Using a sample of 883 black women who were screened for the STAR chemoprevention trial, we compared breast cancer risk estimates from the Gail and CARE models. The mean 5- year breast cancer risk was 0.88% for the Gail model and 1.29% for the CARE model. Using the usual cut-point of 1.67% or above for elevated risk, there is significant difference in the proportion of women with elevated breast cancer risk between the Gail and the CARE models (McNemar’s test, p < 0.0001). Among those with a family history of breast cancer, the mean risk was 1.57% for the Gail model and 1.88% for the CARE model. For both models, there was a significant mean risk difference between those with and without a family history of breast cancer (Wilcoxon rank-sum test, p<0.0001).


The CARE model is an improvement of the Gail model for estimating the risk of invasive breast cancer among black women and will improve counseling, risk assessment, prescribing of chemoprevention agents and eligibility for chemoprevention trials

Citation Information: Cancer Prev Res 2008;1(7 Suppl):A58.

Seventh AACR International Conference on Frontiers in Cancer Prevention Research-- Nov 16-19, 2008; Washington, DC