Gail Model for Breast Cancer Risk
5-year and lifetime absolute risk of invasive breast cancer. Based on the NCI Breast Cancer Risk Assessment Tool (BCRAT). Used to identify women who may benefit from chemoprevention (tamoxifen, raloxifene, aromatase inhibitors).
Score interpretation
Gail model 5-year estimated risk < 1.7% -- average or below-average population risk
→ Standard breast screening (NHS Breast Screening Programme: mammography 3-yearly ages 50-70; extend to 47-73 in trial); breast awareness; lifestyle risk reduction: moderate alcohol (< 14 units/week), healthy weight, physical activity; no chemoprevention indication at average risk; reassess Gail risk every 5 years or with new risk factors.
5-year Gail risk 1.7-3.0% -- elevated; chemoprevention option and enhanced surveillance
→ NICE NG12 elevated risk pathway: annual mammography from age 40; MRI if very dense breast tissue; chemoprevention counselling: tamoxifen 20 mg OD x5 years (pre-menopausal; reduces risk by 38% -- P-1 trial); raloxifene 60 mg OD x5 years (post-menopausal; similar efficacy, less uterine risk -- STAR trial); anastrozole 1 mg OD x5 years (post-menopausal; reduces risk by 50% -- IBIS-II trial); NICE approved for high-risk chemoprevention; risk of tamoxifen: endometrial cancer, VTE, menopausal symptoms; genetics referral if strong family history (BRCA testing criteria).
5-year Gail risk > 3.0% -- high risk; genetics referral and intensive surveillance
→ Genetics referral for family cancer syndrome assessment; BRCA1/2 testing if criteria met; annual MRI breast from age 30 (if BRCA1 or high family history); annual mammography; consider bilateral risk-reducing mastectomy discussion (BRCA carriers with 40-85% lifetime risk); risk-reducing salpingo-oophorectomy if BRCA positive (reduces breast cancer risk by ~50% in BRCA2); chemoprevention (anastrozole or tamoxifen); high-risk clinic review every 6 months; MDT (genetics, oncology, radiology, surgery) involvement.
Interpretation bands for the Gail Model. Apply clinical judgement and local guidance.
References
- Gail MH et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81(24):1879-1886.
- NICE NG12. Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer. NICE. 2013 (updated 2019).
Related
Curated clinical cross-links plus same-class fallbacks.
- Cetuximab · Anti-EGFR Monoclonal Antibody — Head and Neck Cancer
- Cisplatin · Platinum Chemotherapy — Head and Neck Cancer
- Palivizumab · RSV Prophylaxis — Monthly Monoclonal Antibody (High-Risk Infants)
- Ziprasidone · Atypical Antipsychotic — D2/5-HT2A Antagonist (Low Metabolic Risk)
- Atorvastatin (CKD Cardiovascular Risk) · Cardiovascular Risk in CKD
- Tamoxifen · Selective oestrogen receptor modulator (SERM)
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.