Gail's model as first step for early diagnosis: National Cancer Institute of Naples experience

Objective

We started up an intensive program of clinical–instrumental surveillance according to Gail's model. The aim was to increase cases of early diagnosis in women at higher risk.

Methods

For 568 patients, Gail's model risk was evaluated and clinical examination, mammography, and ultrasonography were performed.

Results

According to Gail's model parameters among 568 patients: the mean age of menarche was 12.5 years; according to family history for breast cancer, 43% (244 patients) had a first-degree relative, 24% (136 patients) had a second-degree relative, and 33% (188 patients) had no family history; classes of age most represented were 41 to 50 years (30%) and 51 to 60 years (27%); the mean age of first live birth was 25 years; and according to number of biopsies, 326 patients had previous breast biopsies – 29 patients (9%) positive for atypical hyperplasia and 297 patients (91%) positive for nonatypical hyperplasia. Combining family history with previous breast biopsies showed that, of 380 patients with family history of breast cancer, 154 patients (41%) underwent biopsy and the highest risks were noted in the age class of 51 to 60 years (107 patients).

Conclusion

Thanks to an intensive clinical–instrumental management considering Gail's model, in our breast cancer risk ambulatory program we reached early diagnosis in 13 cases (8.4%), and obtained a reduction of anxiety in women that felt more protected. Gail's model represents the first step toward achieving breast cancer control, particularly paying attention to the relationship between family history and previous biopsies.