A New Online Tool to Determine Breast Cancer Risk

There’s no doubt that a diagnosis of breast cancer can be terrifying: Approximately 232,000 women will be diagnosed with the disease, and 40,000 will die of it in 2015, according to the National Cancer Institute.

However, the decision about when to be screened for the disease can be downright confusing. The American Cancer Society and other health organizations advocate women have an annual mammogram (breast x-ray), beginning at age 40. Meanwhile, the U.S. Preventive Task Force (USPTF), an independent panel of health experts, recommends women 50 and older get mammograms every two years.

Adding to the confusion is the fact that mammograms, which look for signs of breast cancer in women who have no symptoms, are not a perfect diagnostic tool. There is a risk of incorrect results (both finding breast cancer where there is none, and missing actual cancers), and overtreatment. Mammograms also expose women to radiation.

No wonder many women are on the fence about getting screened. And as Margaret Polaneczky, MD, FACOG, watched her patients wrestle with uncertainties about breast cancer screening, she felt compelled to help.

"I came at this as a clinician," explained Polaneczky, an Associate Professor of Obstetrics & Gynecology at Weill Medical College of Cornell University and a practicing OB/GYN physician in New York City. "It’s difficult to help women make informed choices about screening mammography in a short office visit."

So Polaneczky collaborated with Elena Elkin, Ph.D., a researcher at Memorial Sloan Kettering Cancer Center also in New York City, to create a web-based decision aid: BreastScreeningDecisions.com. "The decision aid is designed to be used in a shared decision-making setting—where women become educated about their breast cancer screening choices by using the decision aid, and then discuss their options with their clinician before deciding what to do," says Polaneczky.

About BreastScreeningDecisions.com

The BreastScreeningDecisions.com risk assessment tool consists of about a dozen questions, though you may be asked to answer more if your responses trigger a follow-up. Participants are asked for information on known breast cancer factors such as age, race/ethnicity, age at first period, and family and personal history of breast cancer. Then, based on your responses, BreastScreeningDecisions.com estimates your odds of developing breast cancer in the next five years. The tool is specifically for women in their 40s.

The site also outlines the benefits and harms of mammograms, and helps women evaluate their personal values about screening, such as their tolerance for uncertainty.

"It's helpful to get clarity around what's important to us when we make a decision," Polaneczky says. "It's also important to make decisions based on realistic possible outcomes, not out of a state of fear or anxiety."

Polaneczky and Elkin piloted BreastScreeningDecisions.com to make sure it was acceptable to both women and their clinicians. Since its launch on December 2014, an estimated 1,600 women have used the tool. Anecdotal feedback tells the creators that women find the information very helpful, and that the website has made life easier for doctors.

"BreastScreeningDecisions.com does not aim to tell women what to do," Polaneczky asserts. "We consolidated the available evidence for screening and our current screening recommendations are based on what we know today. It may change tomorrow." The USPTF will update its breast cancer screening guidelines in 2015. If the recommendations change, Polaneczky will revise BreastScreeningDecisions.com accordingly.

Decisions about screening for breast cancer are important. "We want patients to make a choice that’s right for them,” says Polaneczky. “We want them to make an informed choice."

Margaret Polaneczky, MD, FACOG, reviewed this article.


Polaneczky, Margaret, MD, FACOG. Phone interview with author, March 23, 2015.

"Mammograms." National Cancer Institute. Page reviewed March 25, 2014.

"American Cancer Society Recommendations for Early Breast Cancer Detection in Women Without Breast Symptoms." American Cancer Society. Page last revised April 9, 2015.

"Breast Cancer: Screening." U.S. Preventive Task Force. November 2009.

Gotzche, P.C., O.J. Hartling, M. Nielson, J. Broderson. "Screening For Breast Cancer With Mammography." The Nordic Cochrane Centre (2012). Accessed March 23, 2015.

"Breast Screening Decisions." BreastScreeningDecisions.com/Weill Cornell Medical College. Accessed March 23, 2015.

"Breast Cancer and the Environment: A Life Course Approach." National Institute Of Medicine Of The National Academies (2012). Accessed March 23, 2015.

"Breast Cancer Prevention (PDQ®)." National Cancer Institute. Page accessed April 1, 2015.

"About the USPSTF." U.S. Preventive Task Force. September 2014.

"Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement U.S. Preventive Services Task Force." Annals of Internal Medicine 151 (2009): 716-726.

"About Us." Cochrane. Accessed April 1, 2015.