What Is A Breast Cancer Risk Assessment Score? Olivia Munn Says It Saved Her Life

When actress Olivia Munn announced that she had been diagnosed with breast cancer and undergone a double mastectomy in 2023, the 43-year-old thanked her doctor for saving her life. That’s no surprise, but it wasn’t Dr. Thais Aliabadi’s surgical prowess or sharp-eyed mammogram analysis that Munn praised. Munn said Alibadi calculated her breast cancer risk assessment score, which revealed Munn had a 37% risk of developing the condition. So, what is this tool, and why haven’t we all heard of it already?

In her Instagram post about her breast cancer diagnosis, Munn says she tested negative for the BRCA gene — the one most notorious for being associated with breast cancer — and her mammogram from two months before her diagnosis was all clear. “Dr. Aliabadi looked at factors like my age, familial breast cancer history, and the fact that I had my first child after the age of 30,” writes Munn. After her doctor confirmed her risk was high, Munn went in for an MRI, which she says led to an ultrasound, biopsy, and diagnosis of luminal B breast cancer in both breasts.

What is a breast cancer risk assessment score?

The National Cancer Institute website has a free, online breast cancer risk assessment calculator available for anyone to use. You simply fill out the questionnaire to the best of your ability, and the tool will give you two percentages: your risk of developing invasive breast cancer in the next five years, and your risk of developing it in your lifetime. Your personal percentages will appear on the left, with the average risk of women of the same age and race or ethnicity in the general U.S. population presented on the right for comparison.

If you’ve never heard of such a thing, don’t freak out — it’s likely that your doctor is calculating your risk and just not announcing they’re doing so. “Assessing a woman’s risk for developing breast cancer over certain intervals of time is absolutely part of the screening standard of care, because at least one in eight women will develop breast cancer, and the risk for breast cancer among especially younger women varies, based on factors like family history of breast cancer,” says Dr. Sarah Pachtman, M.D., board-certified OB-GYN and maternal-fetal medicine specialist at Northwell Health. “Available breast cancer risk assessment tools ask questions and assess risk based on your number of relatives with breast cancer, your age of first menstrual period, and age at first birth of a child.”

According to the American Cancer Society (ACS), if you are high-risk for developing breast cancer, your doctor will likely recommend a breast MRI in addition to a mammogram every year after you turn 30 (just like Munn was). Screening mammograms, which are different from more targeted diagnostic mammograms, can miss up to 20% of breast cancers, Pachtman says. This is why more frequent screenings, and doing additional screenings with different types of imaging (like MRI), are important for women who are high-risk.

Women who are high risk can also ask their doctors about risk-reducing options, Pachtman says, like medications or surgery. She herself underwent a prophylactic bilateral mastectomy in 2022 because of her personal risk for breast cancer. Her risk was determined by the Tyrer-Cuzick breast cancer risk assessment tool and her own genetic screenings.

So, how much risk is high risk? “A woman is considered to be high-risk if she has at least a 1.67% chance of developing breast cancer in the next five years, or a lifetime risk of at least 20%,” says Pachtman. “This does not include people with a hereditary predisposition to breast cancer, such as those with a BRCA or other high-risk genetic mutations, a history of radiation to the chest, certain medical conditions, or a history of DCIS.”

Who can use the breast cancer risk assessment calculator?

This tool is available for free online to all women, and can be used by any who are age 35 or older. That said, there are some groups who should use this tool mindfully:

• The breast cancer risk assessment calculator was developed based on studies in populations of women, and is not something men should rely on when assessing their risk for breast cancer.
• This tool has been tested in much larger groups of white women than Hispanic, Black, African American, Asian, and Pacific Islander women. It “has been shown to provide accurate estimates of breast cancer risk” in white women, the National Cancer Institute’s website says. However, it “may underestimate risk in Black/African American women with previous biopsies and Hispanic women born outside the United States. The model needs further validation for Hispanic women and other subgroups.” So, women of color may want to discuss any findings in greater detail with their doctor.
• Women with a history of lobular carcinoma in situ (LCIS) or ductal carcinoma in situ (DCIS), or who carry mutations in the BRCA1 or BRCA2 gene, should speak with cancer specialists about their personal risk.

The ACS’ stance on risk assessment tools in general is that they can be helpful, but you should always discuss your results with your doctor.

“These tools give rough estimates of breast cancer risk, based on different combinations of risk factors and different data sets. Because each of these tools uses different factors to estimate risk, they might give different risk estimates for the same woman. A woman’s risk estimates can also change over time. The use of any of the risk assessment tools and its results should be discussed by a woman with her healthcare provider,” the organization says.

So, it’s totally OK to use this tool yourself and keep an eye on your personal breast cancer risk assessment. It’s one more way to be your own advocate. Just be sure you’re bringing those results with you to your primary care and OB-GYN appointments and discussing them further before letting them cause you anxiety.

Expert:

Dr. Sarah Pachtman, M.D., board-certified OB-GYN and maternal-fetal medicine specialist at Northwell Health