Understanding Tyrer-Cuzick

Advances in genomics and risk stratification allow us to tailor breast cancer screening recommendations for individual patients. Risk assessment, in particular, identifies women who are candidates for supplemental screening, genetic counseling, or genetic testing.

Recommendations for Women Based on their Risk Assessment

Tyrer Cuzick breask cancer risk diagram

With the goal of providing personalized medicine, Providence Imaging Center has added the Tyrer-Cuzick (Version 8) risk assessment tool as a complementary addition to our array of breast cancer screening and diagnostic services.

The Tyrer-Cuzik (Version 8) model incorporates a comprehensive set of variables to assess a woman’s lifetime risk of breast cancer. It identifies women at greater than average risk of breast cancer who could benefit from supplemental screening with breast MRI or breast ultrasound. The data collected also identifies families at high risk of hereditary cancer who could benefit from a genetics consultation.

The patient’s lifetime risk calculation will be documented on the mammogram report. Breast cancer screening recommendations for each risk category are listed below:

Average Risk – less than 15%
Continued annual screening mammography is recommended. Screening with tomosynthesis is preferred for women with heterogeneously dense or extremely dense breast tissue.

Intermediate Risk – 15 to 19%
Supplemental screening could be considered for women that fall in this risk category with heterogeneously dense or extremely dense breast tissue, after discussion regarding the risks of false positive and insurance issues. This risk group has insufficient evidence to recommend for or against supplemental screening. Screening breast MRI or ultrasound may be appropriate for selected patients.

High Risk – greater than 20%
The American Cancer Society recommends annual screening breast MRI in addition to annual screening mammography, regardless of density. If the patient is unable to receive MRI, then supplemental screening with ultrasound in addition to routine mammography may be appropriate. For women with elevated risk limited to increased breast density, ultrasound can be considered for adjunctive screening after weighing benefits and risks.

Why measure risk?

  • Identify women that may be at high risk
  • Educate women about their risk
  • Recommend risk based screening
  • Knowing Your Risk
    Do you ever wonder how likely you are to be diagnosed with breast cancer? Unfortunately, breast cancer is very common. The average woman in the United States has about a 12%, or 1 in 8, chance of being diagnosed with breast cancer during her lifetime.
  • Tyrer-Cuzick Assessed Risk Factors
    • Age
    • Height
    • Weight
    • Age at menarche
    • Age at first delivery
    • Age at menopause
    • Breast density
    • Ashkenazi Jewish heritage
    • History of hormone use
    • Genetic testing results for BRCA 1 and BRCA 2
    • Number of daughters
    • Number of sisters & half sisters
    • Number of maternal aunts
    • Number of paternal aunts
    • Atypical breast biopsies, ie: ADH, ALH, LCIS
    • History of breast biopsy/surgery
    • Personal or family history of Breast cancer
    • Age cancer was diagnosed
    • Cancer in one breast or both breasts
  • Breast Cancer Risk Factors
    • Age
    • Contraceptive use
    • Menopausal hormone use
    • Race/ethnicity
    • Serum estradiol level
    • Ashkenazi Jewish ancestry
    • Urine estrogen metabolites
    • Surgical menopause
    • Age at menarche
    • Age at menopause
    • Number of breast biopsies
    • Age at first live birth
    • ADH/LCIS/ALH
    • Age at subsequent births
    • Breast density
    • Radiation exposure
    • Alcohol consumption
    • Family history
    • Parity
    • FH ovarian CA
    • Physical activity
    • Postmenopausal obesity
    • FH other cancers
    • Bone density
    • Genetic mutations
    • Breastfeeding
    • Chest wall radiation
    • Genetic counseling completed
    • Any surgery other than atypical or cancer