Performance of the Gail Model for Breast Cancer Risk Assessment in Iranian Women

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Ramesh Omranipour
Mojgan Karbakhsh
Athena Behforouz
Mohamadreza Neishaboury
Habibollah Mahmoodzadeh
Khojaste Bagheri Koma
Massoome Najafi


Gail model, validation, Iran


Background: The Gail model has been widely used for estimation of absolute risk of breast cancer development. The original model and most of the validation studies have been performed among western populations and controversial results have been reported regarding the applicability of this model in Asian populations. Our aim was to investigate the performance of this model in Iranian women.

Methods: In a cross-sectional study, a total of 280 patients with breast cancer and 280 participants with normal screening results were enrolled as case and control groups, respectively. Risk factors used in the latest version of the Gail model were compared between the two study groups. Gail score was calculated by using Breast Cancer Risk Assessment Tool and based on the cut-off point of 1.67, patients were categorized in order to assess model performance.

Results: In total, 560 patients with a mean age of 43.07±8.60 years were enrolled. Comparison of different risk factors between the two groups revealed significant associations of patients’ age (P < 0.001), age at first pregnancy (P = 0.022), previous history of breast biopsy (P < 0.001) and atypical hyperplasia (P = 0.002) with risk of breast cancer. No association was found between age at menarche (P = 0.115) or first-degree family history (P = 0.117) and increased risk. Considering the Gail score for 5-year risk of breast cancer development, the difference between the two groups failed to reach significance (P = 0.052). The sensitivity and specificity of the model were 13.9% and 94%, respectively.

Conclusions: Based on the current findings, it can be suggested that employing the current version of the Gail model for breast cancer risk assessment will underestimate the risk of cancer development in Iranian women.

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