.cancer risk assessment is an important part of the initial evaluation of
a patient .A patient's cancer risk is not only an important determinant­
of cancer screening recommendations but also may alter how
.aggressively an in determinant finding will be pursued for diagnosis.
;a probably benign mammographic lesion. for example. defined as with less than a 2% probability of malignancy ­•  is usually managed with a 6-month
 follow up mammogram in a patient at baseline cancer risk.but
obtaining a tissue diagnosis may be preferable in a patient at high
risk for breast cancer

Cancer risk assessment starts with a complete history that includes history of environmental exposures to potential carcinogens and a detailed family history. Risk assessment for breast cancer, for example. includes a family history to determine whether another member of the family is known to carry a breast cancer susceptibil­ity gene; whether there is familial clustering of breast cancer. ovarian cancer. thyroid cancer, sarcoma, adrenocortical carcinoma, endome­trial cancer. brain tumors, dermatologic manifestations. leukemia, or lymphoma; and whether the patient is from a population at in­creased risk  Patients who have a family history suggestive of a cancer suscepti­bility syndrome such as hereditary breast ovarian syndrome. LFS. or CD would benefit from genetic counseling and possibly genetic testing
Patients who do not seem to have a strong hereditary component of risk can be evaluated on the basis of their age. race, personal history, and exposures. One of the most commonly used models
for risk assessment in breast cancer is the Gail model Gail
 The model uses risk factors such as an individual's age. age at menarche. age at first live birth, number of first degree relatives with breast cancer. number of previous breast biopsies, and whether the biopsies revealed atypical ductal hyperplasia . The NationaI Cancer Institute (NCl) and the National Surgical Adjuvant Breast and Bowel Project (NSABP) Biostatistics Center developed a breast cancer risk assessment tool, which is available on the World Wide Web, that is based on the Gail model. This tool incorpo­rates the risk factors utilized in the Gail model, as well as race and ethnicity. and allows a health professional to project a woman's in­dividualized estimated risk for invasive breast cancer over a 5-year period and over her lifetime (to age 90 years). Notably, these risk projections assume that the woman is undergoing regular clinical breast exams and screening mammograms. Also of note is that this program underestimates the risk for women who have already bad a diagnosis of invasive or noninvasive breast cancer, and does not take into account specific genetic predispositions such as mutations in BRCAl or BRCAl. However, these risk assessment tools have been validated and are now in widespread clinical use. Simi­lar models are in development or being validated for other cancers. For example, a lung cancer risk prediction model, which includes
age, sex. asbestos exposure history, and smoking history, has been found to predict risk of lung cancer

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