After negative cancer gene test results and normal mammograms, actress Olivia Munn was diagnosed with breast cancer.
In an Instagram post, Munn wrote that her OB-GYN decided to calculate her breast cancer risk assessment score using a risk stratification, saving her life. That's because an MRI later revealed an abnormality that the mammograms and genetic testing did not detect.
Munn underwent a double mastectomy and urged others to get a risk assessment.
Dr. Matilde Francois is a surgeon at the High-Risk Breast Clinic at Carle Cancer Institute in Normal. She said risk stratification is an online tool that is used to calculate an individual’s probability of developing breast cancer in their lifetime.
“(Munn) undergoes this risk stratification and it comes out that she is considered high-risk, despite having had normal mammograms in the past and normal genetics,” Francois said in an interview for WGLT's Sound Health. “Her gynecologist recommends that she undergo a breast MRI as part of her surveillance that’s recommended because of her high-risk.”
“MRIs are sensitive tests that are very useful in helping us monitor patients who we consider to be high-risk. And since she was diagnosed with that high-risk potential, an MRI became part of her surveillance and that’s what led to her earlier diagnosis of her breast cancer,” Francois continued.
Francois said the Tyrer-Cuzick or IBIS risk tool is most commonly used to assess a woman’s 10-year and lifetime risk of developing breast cancer. The tool is like an online questionnaire; it asks about age, menstrual history, medical history, history of having children, breast density from mammograms, irregular mammograms or biopsies, family history and more.
The Gail Model is also commonly used, but it does not take family history into account as much as the Tyrer-Cuzick model does, Francois said.
“None of these tests are able to tell us 100% if you will get cancer, but they tell us who to monitor more aggressively,” Francois said. “The general population of women have about a 13% chance, on average, of developing breast cancer in their lifetime—so by the time they’re 85-years-old.”
The American College of Radiology now suggests that breast cancer risk assessment should be performed by age 25.
While risk stratification tests are available online for patients to do at home, Francois said it can be difficult to fill out alone if patients are unsure about their breast density or diagnoses of breast biopsies.
The High-Risk Breast Clinic at Carle follows high-risk cancer patients and provides them with up-to-date medications and recommendations for treatment and services.
“We have found that patients can’t know whether or not they’re high-risk until someone basically tells them that they are,” Francois said. “It’s not like we’re all born with a sign that says ‘I’m at high-risk for colon cancer,’ or ‘I’m at high-risk for breast cancer.’”
Francois noted women should get their first mammogram by age 40—sooner if they have a relative who was diagnosed with breast cancer at a young age.
“We end up finding out through our lifetime that there are parts of our family history that make us high-risk or part of our genetic makeup that make us high-risk, and as those patients become identified, they need to have a place to go so they can have appropriate follow-up and management to the risk that they’ve now been diagnosed with,” she said.
