Applicability of the Gail model for breast cancer risk assessment in Turkish female population and evaluation of breastfeeding as a risk factor
The Gail model is considered the best available means for estimating risk of breast cancer development, but it has not yet been applied systematically and validated in Turkish female population. This study was designed to evaluate the performance of the Gail model for Turkish female population. Additionally duration of breastfeeding was examined as a possible risk factor. Our analysis included 650 patients with invasive breast carcinoma (group 1) and 640 women with negative results who had undergone a screening mammography on visiting a mammary care unit (group 2). Two groups were compared with regard to individual risk factors included in the Gail model and also duration of breastfeeding. The Gail model was used to predict 5-year risk for each woman. Age and first live birth ≥30 years were associated with an increased relative risk for breast cancer development. Age at menarche, previous breast biopsy, atypical hyperplasia, and number of first degree relatives with breast cancer were found to be non-significant. The Gail model showed 13.3% sensitivity and 92% specificity in estimating the risk of breast cancer development in Turkish women. Positive predictive value was 63%, negative predictive value was 51.9%, and validity index was 53.1%. Duration of breastfeeding was significantly longer in group 1 than 2 (median 17 vs. 13 months). The proportion of parous women with no breastfed was higher in group 1 than 2. The currently used Gail model does not seem to be an appropriate breast cancer risk assessment tool for Turkish female population.