A Unified Approach to Stopping Breast Cancer Before It Starts

Learn how scientists are connecting prevention, risk, and intervention research to thwart breast cancer.

A breast cancer diagnosis can bring uncertainty and fear—but there’s also reason to feel hope. Today, thanks to breast cancer research advancements in prevention, risk assessment, and treatment, patient outlook is better than ever: The average five-year survival rate exceeds 90 percent, and ongoing research continues to build on that success.

A future without breast cancer requires multidisciplinary research. Because this complex disease is driven by a number of factors (family history, biology, lifestyle, environment, and more), preventing and treating it requires the innovative minds of a diverse combination of experts. That’s why BCRF supports collaboration between interconnected disciplines—biology, genetics, epidemiology, and more—to improve breast cancer outcomes. And our researchers are committed to breast cancer prevention, which is especially important for those at high-risk or with a strong family history.

The evolving science of breast cancer risk assessment

A vital aspect of improving breast cancer outcomes is risk assessment; that is, learning your individual chances of developing breast cancer.

Traditional breast cancer risk assessment methods involve questionnaires administered by a medical provider that ask for details about age, family, lifestyle, reproductive history, and other factors. The widely used Gail Model, also known as BRCAT (Breast Cancer Risk Assessment Tool), estimates an individual woman’s risk of developing breast cancer over the next five years and in the course of her lifetime (up to age 90). However, it can’t accurately assess risk for certain subgroups, including women who have a mutation in the BRCA1 or BRCA2 gene. For those who have one of these or other mutations associated with the disease, there are alternative models—for instance, the Tyrer-Cuzick Model, which was developed by BCRF investigator Dr. Jack Cuzick—that take a more in-depth look at family history.

Over the past few years, high-tech advancements have taken breast cancer risk assessment to the next level. In addition to testing for mutations in a single gene, today we also have polygenic risk scores (now part of the Tyrer-Cuzick Model), which take into account hundreds of tiny variations in DNA and offer a uniquely personalized snapshot of how your genetics influence your individual risk.

In 2025, the FDA granted de novo (first-of-its-kind) authorization to Clairity Breast, which uses artificial intelligence to predict a woman’s chances of getting breast cancer over the next five years based on a standard mammogram. BCRF supported the development of Clairity Breast and is also supporting its rollout across the U.S., ushering in a new era of individualized screening tailored to risk.

Understanding who is at high risk—and why it matters

When people are more informed about their personal chances of developing breast cancer, they can make better decisions with their doctor about preventive screening—when to start, how often to screen, and whether to supplement a standard mammogram with other methods such as MRI or ultrasound. This is particularly essential for people at a high risk for breast cancer, including those who have:

• inherited genetic mutations, including mutations of the BRCA1 and BRCA2 genes as well as lesser-known genes such as ATM and PALB2
• first- or second-degree relatives on either side of their family with breast cancer
• previous experiences with certain cancers, breast and otherwise
• past radiation therapy during childhood, adolescence, or young adulthood, particularly radiation to the chest
• certain noncancerous breast conditions, such as fibroadenomas or cysts
• started menstruation before age 12 or menopause after 50, which increases lifetime exposure to estrogen

The breast cancer risk factor you may not know about

Research suggests that breast cancer risk and outcomes after diagnosis can vary across different ethnic and racial groups:

• Black women are 38 percent more likely to die of breast cancer.
• Black and Hispanic women are diagnosed at earlier ages and are more likely to develop triple-negative breast cancer, a more severe form of the disease.
• Native women are diagnosed 10 percent less frequently than white women, but their mortality rate is six percent higher.
• Women in the Asian American/Pacific Islander community, despite their higher overall survival outcomes, are experiencing a faster rise in breast cancer cases than any other racial or ethnic group.

There are several potential factors that alone or in combination could contribute to these disparities. Socioeconomic circumstances, for example, may mean limited access to healthcare services such as screening or genetic counseling. They may also influence other factors that contribute to obesity, a known breast cancer risk factor, such as poor diet. Unconscious bias may lead healthcare providers to be less vigilant about testing and treatment for non-white patients. Cultural stigma may stifle open conversations about breast cancer, impeding awareness of how to prevent or screen for the disease. And finally, breast cancer research has primarily focused on white women, potentially missing biological differences that could help illuminate the way breast cancer affects people of color.

BCRF investigators are working to help close this gap, putting their individual expertise to work to further understand the multitude of factors—psychological, sociological, and biological—that influence survival rates for women of all ethnicities.

Why risk assessment matters

When it comes to positive outcomes from breast cancer, early detection is key. When cancer spreads to nearby locations such as the lymph nodes, known as locoregional breast cancer, the survival rate drops to 87 percent. For so-called distant or metastatic breast cancer—cancers that have spread beyond the breast to other organs—the rate drops to 32 percent.

Although risk assessment methods can’t predict the future, they can help guide those at a higher risk for breast cancer to take proactive measures, such as seeking genetic testing, more in-depth screening, chemopreventive drugs, or preventive surgery. The options are as personal and individual as the disease itself—but no matter your particular risk(s), it’s imperative to be aware and address them with your healthcare team as necessary.

Breast cancer prevention research: new paths to lowering risk

Thanks in part to developments in early detection and treatment, breast cancer mortality has significantly dropped since 1989, even while incidence rates have been relatively steady over the same period. Researchers are therefore trying to home in on why breast cancer develops in the first place, so we can stop the disease in its tracks. BCRF funds a number of promising studies in breast cancer prevention, including:

• identifying biomarkers (such as proteins or other factors) that can be used as early signals of breast cancer
• developing new interventions or targeted therapies designed to intercept cancer before it starts
• developing prevention vaccines
• determining how social drivers of health interact with genetics to increase breast cancer risk

From knowledge to action: interventions for high-risk patients

For high-risk individuals, targeted prevention holds great promise. BCRF is funding projects including those as part of the Precision Prevention Initiative (PPI), which brings prevention research into the realm of precision medicine by targeting an individual’s unique risk.

Work from phase one of PPI has uncovered ingenious ways that high-tech tools could help further risk detection, including artificial intelligence (AI)/machine learning and advanced imaging. It also includes the latest findings from researchers like BCRF investigator Dr. Olivera Finn, whose team is researching a breast cancer vaccine to prime the immune system against cancer. Better risk stratification empowers patients to make informed decisions and may lead to less invasive options.

Knowledge is empowerment

The diverse field of breast cancer research is yielding new developments every day. With the help of BCRF and other organizations, 18 new breast cancer treatments have been approved by the FDA in just the past decade. These efforts came about through collaboration and a unified strategy, not isolated approaches.

The best way to protect yourself against breast cancer is to stay informed and on top of your risk. Breast cancer is complex, but scientists and clinicians, supported by donors and stakeholders in the breast cancer community, are working to ensure that the strides we’ve made are just the beginning. To make an even bigger difference, you can help BCRF raise funds for further research across the breast cancer continuum: Start today to help support tomorrow’s breakthroughs.

Frequently asked questions about breast cancer risk assessment

1. What is breast cancer risk assessment?

Breast cancer risk assessment looks at different aspects of your health and personal history to estimate your chances of developing breast cancer. These factors can include your age, family history, genetics, breast density, reproductive history, and lifestyle or environmental influences. Understanding your risk can help guide decisions about screening and ways to reduce your risk.

2. How accurate are breast cancer risk assessment tools?

Breast cancer risk assessment tools are becoming more accurate as traditional questionnaires—such as the Gail Model or the Tyrer-Cuzick Model, which consider factors like lifestyle and personal health history—are increasingly combined with newer technologies, including genetic and polygenic risk scores. However, these tools are not designed to predict the future with certainty. Their accuracy can vary from person to person and across different populations. Ongoing research, including studies funded by BCRF, is focused on improving and personalizing risk assessment to support more precise prevention strategies.

3. What is the Gail Model?

The Gail Model is one of the most commonly used tools for assessing breast cancer risk. It is a questionnaire-based model that estimates a person’s likelihood of developing breast cancer within the next five years and over her lifetime. However, it’s not designed for individuals with known genetic mutations, such as BRCA1 or BRCA2, or for those with other factors that place them at higher risk.  

4. What is the Tyrer-Cuzick model?

The Tyrer-Cuzick model (also called International Breast Intervention Study, or IBIS) is a widely used breast cancer risk assessment tool, particularly helpful for individuals with a family history of breast cancer or genetic risk factors. In addition to other factors such as reproductive history and breast density, it accounts for inherited risk by using a polygenic risk score based on the analysis of hundreds of genetic variations.

5. Who is considered high risk for breast cancer?

A person may be considered high risk if they have a strong family history of breast cancer, inherited genetic mutations (such as BRCA1 or BRCA2), previous chest radiation, certain benign breast conditions, or a combination of factors identified through a risk assessment tool.

6. At what age should BRCA testing be done?

Genetic testing isn’t recommended for everyone, but it can reveal important information for individuals with a strong personal or family history of breast, ovarian, or pancreatic cancers or for those who have a close family member with a known mutation in breast cancer susceptibility genes such as BRCA1 and BRCA2. Decisions about if and when genetic testing is appropriate for you should be made in consultation with your healthcare provider or a genetic counselor.

6. If I’m high-risk, what prevention options are available?

If you are considered high-risk, several prevention options may be available. These can include enhanced screening (for example, an annual MRI in addition to routine mammography), preventive medications such as tamoxifen or raloxifene, lifestyle modifications (quitting smoking, limiting alcohol intake, maintaining a healthy diet, and regular exercise), genetic counseling, and, in some cases, risk-reducing surgery. The most appropriate approach depends on an individual’s specific risk factors. Ongoing BCRF-funded research continues to refine these strategies and improve their tailoring to individual risk levels.

8. How does breast cancer prevention research help reduce risk?

Prevention research uncovers factors that contribute to the development of breast cancer and tests strategies that can stop cancer before it begins, such as targeted medications, lifestyle interventions, and biomarker-based approaches. Advances in this field, supported by organizations like BCRF, are helping make prevention more effective and personalized.

9. What clinical trials exist for people at high risk of breast cancer?

Clinical trials for people at high risk of breast cancer test new screening methods, medications, lifestyle interventions, and other prevention strategies. These trials help researchers better understand who is at risk and how to prevent breast cancer earlier and more effectively. You should discuss your options with your doctor or a genetic counselor.