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Breast cancer is the most common cancer and second leading cause of cancer deaths in women in the United States. In 2008, approximately 184,450 patients are estimated to be diagnosed with invasive breast cancer and an estimated 40,930 were killed on this disease. In addition, more than 50,000 breast cancer carcinoma in situ cases would be diagnosed. The etiology of breast cancer is poor with multiple genetic and environmental factors in initiation and progression of cancer involved understand. Scandinavian Twin Study: For years, there is a heated debate over whether the cause of breast cancer is genetic and the environment was. Then, in 2000, Lichtenstein and his colleagues at the Karolinska Institute in Sweden published their study of 44,788 pairs of twins from the Swedish, Danish, Finnish, and recordings doubles. In this study looked at cancer risk by 28 different types of cancer and did the statistical modeling of the contributions of genetic and hereditary in eleven different types of cancer. In the case of breast cancer, have clearly shown that only 27% of breast cancers are due to genetic factors. This was a hereditary component, although lower than in other common cancers, like prostate cancer and colon cancer. These and other studies have shown that over 70% of breast cancers are influenced by environmental factors, is confirmed. BRCA genes: Although much attention has been submitted to breast cancer, only two genes are often tested in breast cancer risk assessment. These two genes are called tumor suppressor genes BRCA1 "and" BRCA2 ", which are involved with DNA repair. These two genes are only 5% of all breast cancers. Because Scandinavian twin study, many experts believe that there are others to discover the genes involved with breast cancer. Since the probability that a BRCA mutation is so low in the general population, genetic testing is indicated in most patients. However, if a patient has a family history of breast cancer, so a mathematical model can be used to determine if the BRCA test is displayed. The probability of a BRCA carrier with the growing number of relatives who had cancer, and whether the cancer occurred earlier in life. Be found, for example, in families with four or more cases of breast or ovarian cancer under the age of 60, over 80% so as to have a corrupted version of BRCA1 or BRCA2. If a patient is a carrier of one or both of the genes BRCA1 and BRCA2, the risk of breast cancer increases dramatically. According to the estimates of life-threatening, such as 13 2% (132 in 1,000) of women in the general population of developing breast cancer, compared to estimates of 36-85% (360-850 of 1000) of women with altered gene BRCA1 or BRCA2. In other words, are women with altered BRCA1 and / or BRCA2 cancer gene up to eight times more likely to breast cancer than women without alterations in genes for development. The mutation of the BRCA1 gene confers a higher risk than BRCA2 mutation. Women who inherit a damaged BRCA1 gene have a probability of 60-85% percent of developing breast cancer at times in their lives, and a 20-40% chance of developing ovarian cancer. For BRCA2, the risks of 40-60% and 10-20%, respectively. The family history and Breast Cancer: Although the place is breast cancer BRCA genes are turned, the majority of patients with a family history of breast cancer, BRCA1 and BRCA2-negative. Even in these BRCA-negative patients, however, there is an increased risk of cancer, with a family history of breast cancer. Six factors (which have nothing with BRCA genes) examined in patients with a family history of breast cancer. They are: 1 relationship: if the family member with a history of cancer, a bachelor's, is the increased risk is much greater than for the second degree. 2. Had a number of relatives who have breast cancer: people with two or more family members who had breast cancer that affects a higher risk than those with only a relative. 3. The age of onset of cancer, though its development of breast cancer at an early age () before the menopause, the risk is higher if the relative developed post-menopausal breast cancer. 4. Bilateral breast cancer: If your relative has a history of bilateral breast cancer, the risk is greater with a relative with unilateral breast cancer. 5. The sex of the parent, if the family is a man with breast cancer, the risk is greater. 6. OTHER early onset of cancer, if it caused a family history of early onset ovarian cancer, this is an increased risk of a person. How to decide if you have the BRCA gene test takes Following is an excerpt from the American Society of Breast Surgeons: 1 early-onset breast cancer (diagnosed before 50 years) 2. Two primary breast cancers, 3 bilateral or ipsilateral A family history of early onset breast cancer4. Male breast cancer5. A personal or family history of ovarian cancer 6 Ashkenazi (Eastern Europe) Jewish heritage 7 A previously identified BRCA1 or BRCA2 mutation in the family Each of these risk factors alone to host a BRCA1 or BRCA2 mutation. The presence of more than one of these functions increases the risk of more than 10%, the traditional cut for the recommendation, a BRCA test. These patients should have access to BRCA testing. A simple model for calculating the risk on the prevalence of mutations among women tested for BRCA mutations seen base is available at http://www. brcacalculator. com.

With known risk factors for breast cancer, mathematical models can be developed to respond to important questions. These mathematical models are useful tools for researchers and patients as follows: 1 The research on risk factors – The risk assessment Claus model was used for the subpopulation of people who had autosomal dominant allele that increases the risk by 10% 92% open. This has led to the discovery of BRCA genes in breast cancer that are linked to prostate cancer and ovarian cancer. 2. Clinical Trial Eligibility – The Gail model risk assessment was developed to help researchers determine who enroll in Breast Cancer Prevention NSAPB chemoprevention trials, which has been shown to reduce the risk of breast cancer. 3. Guidelines for BRCA testing – BRCA test is very expensive and practically anything if it is at all (because it is so rare that, for the BRCA1 or BRCA2 homozygotes). Mathematical models such as BRCAPRO, BOADICEA Tyrer and Cuzick models can help determine which patients should undergo BRCA testing. The decision to test is a rule, if one of these models by 10% or greater chance that a mutation in BRCA1, BRCA2, or both genes predicts. 4. Guidelines for screening for breast cancer MRI – magnetic resonance imaging screening for breast cancer is not a cost-effective screening test for the general population, but in some groups, there are clear reasons for doing so. In general, MRI screening for women with 20-25% or more the risk of breast cancer recommends life. The BRCAPRO Tyrer and Cuzick models were used to help make clinical decisions to order MRI for screening for breast cancer. 5. Guidelines for Breast Cancer Therapy – The Gail model is used clinically to determine who will be put to tamoxifen or raloxifene for chemoprevention. Other models have been used to make decisions about the reduction of breast cancer risk with prophylactic mastectomy. For these reasons, it is important to understand these models. These models are collectively referred to as "tools of risk assessment. The following paragraphs summarize the most popular and most used tools for risk assessment. Note that none of these tools for assessment of risk to the survival of breast cancer. No mathematical model has been generally accepted for determining the risk of cancer in women cancer survivors. General Gail Model Risk Assessment Tools: Gail model is a validated risk assessment model that focuses primarily on risk factors, not inherited, with only limited information on family history. It was not the help of scientists at the National Cancer Institute and the National Surgical Adjuvant Breast and bowel Project (NSABP) health care providers question the risk of breast cancer, to determine their eligibility for the Breast Cancer Prevention Trial developed. The tool allows a woman, an individual assessment of risk of breast cancer over a period of five years and his life project. See also the assessment of women at risk with average risk for a woman the same age. The Gail model is an online quiz that has 13 questions and interactive. This calculation was published statistics of risk and methods offered by the peer-reviewed journals, and has been extensively tested for its validity. The major limitation of the Gail model is the inclusion of only first degree relatives, which leads to an underestimation of risk in 50% of families with cancer in the paternal line, and also takes no account of age of onset of cancer breast. It may underestimate the risk in some groups, such as obese patients. National Cancer Institute, Model: The NCI-risk analysis is essentially a simplified model of Gail, who also factors in the race. Race is a factor in determining the risk of breast cancer is excluded, however, if the eligibility for clinical trials. This tool is probably the most important tool for risk assessment available to the public as a computer interactive online risks. The online quiz is a short, nine point questionnaire includes a number of factors, so that future five-year to a woman's risk of breast cancer and their lifetime risk of breast cancer. The NCI does not take into account a number of risk factors that can be changed. For this reason, it is difficult to use this test as a reason to show people how life can change the risk of breast cancer. It can not be used in survivors of breast cancer in patients with ductal carcinoma in situ, LCIS, or persons bearing one of the BRCA genes. BRCAPRO: This is a statistical model is available as a computer program that determined using two different algorithms to identify a family physician and assist the probability that a mutation of the gene BRCA1 or BRCA2 mutation in a family. The results of this can be used to determine if the BRCA test is displayed. This is very useful in view of the high cost of BRCA testing (3,000 dollars). None of hereditary risk factors may be incorporated in the model, however. In a comparison of four different methods for estimating the risk of breast cancer in patients with a family history of breast cancer, was the model BRCAPRO less accurate. Expects only 49% of breast cancers, and it felt right in the group of patients with a family history of breast cancer occurred. Harvard Center for Cancer Prevention Risk Assessment Tool: This is another analysis of breast cancer risk factors including lifestyle and more as the Gail model or NCI Tools. Is not as widely studied as a model of Gail NCI and the simplified model, but it is encouraging that there are many lifestyle factors that people can do, including their foreign exchange risk to cancer. It is also an online questionnaire that will be used by men and women to enable them to assess their risk of breast cancer. In all practices now, after a thorough discussion of all these models of confusion and statistics that make, when all the information at hand. What is the best way to get a patient to accurately assess their risk of breast cancer and, if possible, to show what positive factors and reduce their risk of negative factors can be modified to reduce the risk? If possible, to help, it would be nice to show the patient the value and indications for examination, imaging, chemoprevention, and in some cases, surgery. A discussion on the practical side of each of them is here in a Q & A format: Q: What kind of (free) on-line programs can be used to assess the risk of a patient of breast cancer? A: Some of the tools of risk assessment referred to above can be freely made available to the general public. Here are the tests and their sites: 1 Your risk of disease – English version: http://www. diseaseriskindex. Harvard. edu This is a great interactive questionnaire that will be five years and the risk of breast cancer life from Harvard Center for Cancer Prevention developed and published online calculation in 2000. In 2005 he launched the Spanish version of the site, "cuidar de su Salud. The computer includes risk lifestyle such as weight, diet, vegetables, consumption of alcohol, and Jewish ethnic origin. It does not include other ethnic groups, however, and is not applicable for carriers of BRCA mutations or survived breast cancer. Despite these problems, this is by far the best free online risk calculator, since they are very interactive and offers a personal description of the risk in the form of a colored bar, which can be manipulated electronically to experience "virtual" reduction risk. The bar chart is a seven-point scale, with the user, typical of a man or woman of your age in comparison. Users will know where to focus their efforts on prevention and on changing lifestyles to brands, click on "personal strategies. With each click, it reduces the bar chart, and the user sees his risk drops expected. This is a great concept, to motivate people to participate and in accordance with measures to change lifestyles. 2. The NCI Risk Assessment Tool-regular Web: http://www. Cancer. gov / bcrisktool This is the easy to use, on-line questionnaire, based on a modified Gail model, which also ethnicity. No matter a personal history of breast cancer, ductal carcinoma in situ or LCIS. It does not take into account other factors such as BRCA status, hormone replacement therapy, lifestyle, lactation, menopause, or density mammogram. Despite these problems, it is a very useful tool for a woman for five years and lifetime risk of breast cancer. And 'the only instrument that can affect the risk assessment of mobile handheld devices are used (any kind). A version of this operating system can be downloaded as well as for Windows Pocket PC PDA. Q: What are the programs can be used for one medical decisions regarding the appointment of a breast MRI? A: The American Cancer Society has developed some very good guidelines for breast screening with MRI. E 'should be emphasized that MRI be complementary to mammography, not a substitute. 1. A Cancer Journal for Clinicians – http://caonline. amcancersoc. org/cgi/content/full/57/2/75 2 BRCPRO – ver. 4. 3 available @ http://www4. utsouthwestern. / Maternal health edu / cagene / default. asp