The Breast Cancer Risk Assessment Tool (BCRAT) can estimate a female’s risk of developing breast cancer in their lifetime, but it cannot tell who will get breast cancer or not.
The BCRAT is a short questionnaire that calculates a female’s lifetime risk of developing invasive breast cancer. People may also refer to the BCRAT as the Gail model.
This article discusses the BCRAT in more detail, including its accuracy, risk factors for breast cancer, and how a person can help reduce their risk.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
The BCRAT uses certain information about a person’s medical history, reproductive history, and family history of breast cancer to
Healthcare professionals can use the BCRAT to estimate the risk of a female developing invasive breast cancer in the next 5 years through to the age of 90 years. This is called the lifetime risk.
The BCRAT can estimate absolute breast cancer risk. “Absolute risk” is the risk of developing breast cancer across a certain time period.
The BCRAT
- breast cancer history
- history of chest radiation therapy for Hodgkin’s lymphoma
- genetic mutation of the BRCA1 or BRCA2 gene, or a diagnosis of genetic risk factors for breast cancer
- age (between 35 and 85 years)
- race and ethnicity, and in some cases, place of birth or subrace or ethnicity
- medical history of breast biopsy with benign diagnosis or atypical hyperplasia
- age of first menstrual period
- if a person has given birth, the age they gave birth to their first child
- number of first-degree relatives who have had breast cancer
The calculator uses the answers to these questions to estimate a person’s risk for breast cancer.
There are
Nonmodifiable risk factors
Breast cancer risk factors that people cannot control include:
- age, as breast cancer risk increases with older age
- certain inherited genetic mutations
- starting menstrual periods younger than 12 years old
- starting menopause after the age of 55
- dense breasts, which can increase the risk of breast cancer and can make diagnosis more difficult
- history of breast cancer or some types of noncancerous breast disease
- family history of breast cancer or ovarian cancer
- radiation therapy to the chest before the age of 30
- exposure to diethylstilbestrol (DES), a drug that people may have had during pregnancy between 1940 and 1971 in the United States
Modifiable risk factors
Breast cancer risk factors that people can change include:
- reduced physical activity
- having overweight or obesity after menopause
- taking some birth control pills
- taking hormone replacement therapy containing both estrogen and progesterone during menopause for more than 5 years
- having a first pregnancy after the age of 30
- not breastfeeding or chestfeeding, whether they have a choice to do so or not
- never having a full-term pregnancy
- drinking alcohol
Learn more about breast cancer risk factors.
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- The calculator may underestimate breast cancer risk in Black females who have had previous biopsies and Hispanic females who were not born in the United States.
- There is also limited data on American Indian/Alaska Native females. For this reason, estimates may not be accurate as they are partially based on data from white females.
The calculator is not an accurate tool for estimating breast cancer risk in the following cases:
- people with a BRCA1 or BRCA2 genetic mutation
- individuals with a history of invasive breast cancer or in situ breast cancer, which includes lobular carcinoma in situ (LCIS) or ductal carcinoma in situ (DCIS)
- people with an inherited breast cancer-causing syndrome, such as Li-Fraumeni syndrome
The BCRAT is not an accurate tool for everyone. People with certain medical histories
- People with a history of LCIS can use the IBIS Breast Cancer Risk Evaluation Tool.
- People with a known mutation of the BRCA1 or BRCA2 gene can use the BOADICEA model.
A person can consult a doctor to discuss their breast cancer risk. This is particularly important if they have:
- a history of DCIS
- a history of radiation therapy to the chest for Hodgkin’s lymphoma
- history of breast cancer
- an inherited breast cancer-causing syndrome
People may be able to
- achieving and maintaining a moderate weight
- keeping physically active with moderate to vigorous exercise
- limiting or avoiding alcohol
- eating a nutritious diet
- nursing for several months after childbirth
- taking nonhormonal methods for treating menopause symptoms
People with an increased risk of breast cancer may also consider the following:
- genetic counseling to test for breast cancer risk
- medications to reduce breast cancer risk
- preventive breast or ovarian surgery
- close monitoring, such as more frequent breast exams and earlier screening tests
Learn how to do a breast self-examination.
Breast cancer resources
Visit our dedicated hub for more research-backed information and in-depth resources on breast cancer.
The BCRAT is a tool females can use to estimate their lifetime risk of developing invasive breast cancer.
A person answers a short questionnaire on medical and reproductive history to assess their breast cancer risk.
The BCRAT can estimate risk, but it cannot predict who will or will not develop breast cancer.