The Breast Cancer Risk Assessment Tool (BCRAT) can estimate a female’s risk of developing breast cancer in their lifetime, but it cannot tell who will get breast cancer or not.

The BCRAT is a short questionnaire that calculates a female’s lifetime risk of developing invasive breast cancer. People may also refer to the BCRAT as the Gail model.

This article discusses the BCRAT in more detail, including its accuracy, risk factors for breast cancer, and how a person can help reduce their risk.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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The BCRAT uses certain information about a person’s medical history, reproductive history, and family history of breast cancer to estimate the risk of developing invasive breast cancer.

Healthcare professionals can use the BCRAT to estimate the risk of a female developing invasive breast cancer in the next 5 years through to the age of 90 years. This is called the lifetime risk.

The BCRAT can estimate absolute breast cancer risk. “Absolute risk” is the risk of developing breast cancer across a certain time period.

The BCRAT requires the following personal information:

  • breast cancer history
  • history of chest radiation therapy for Hodgkin’s lymphoma
  • genetic mutation of the BRCA1 or BRCA2 gene, or a diagnosis of genetic risk factors for breast cancer
  • age (between 35 and 85 years)
  • race and ethnicity, and in some cases, place of birth or subrace or ethnicity
  • medical history of breast biopsy with benign diagnosis or atypical hyperplasia
  • age of first menstrual period
  • if a person has given birth, the age they gave birth to their first child
  • number of first-degree relatives who have had breast cancer

The calculator uses the answers to these questions to estimate a person’s risk for breast cancer.

There are risk factors for breast cancer that people cannot change, such as genetics, and other risk factors that people can help manage, such as lifestyle factors.

Nonmodifiable risk factors

Breast cancer risk factors that people cannot control include:

  • age, as breast cancer risk increases with older age
  • certain inherited genetic mutations
  • starting menstrual periods younger than 12 years old
  • starting menopause after the age of 55
  • dense breasts, which can increase the risk of breast cancer and can make diagnosis more difficult
  • history of breast cancer or some types of noncancerous breast disease
  • family history of breast cancer or ovarian cancer
  • radiation therapy to the chest before the age of 30
  • exposure to diethylstilbestrol (DES), a drug that people may have had during pregnancy between 1940 and 1971 in the United States

Modifiable risk factors

Breast cancer risk factors that people can change include:

Learn more about breast cancer risk factors.

According to the National Cancer Institute, the BCRAT may be accurate for estimating risk, but this does not always predict who will or will not develop breast cancer. Some people with high risk factors will not develop breast cancer, while others with a lower risk may.

A 2018 systematic review found the BCRAT more accurate for predicting breast cancer in American and European females. The tool may overestimate the risk by around twice as much in Asian females.

According to the National Cancer Institute, the BCRAT has the following limitations:

  • The calculator may underestimate breast cancer risk in Black females who have had previous biopsies and Hispanic females who were not born in the United States.
  • There is also limited data on American Indian/Alaska Native females. For this reason, estimates may not be accurate as they are partially based on data from white females.

The calculator is not an accurate tool for estimating breast cancer risk in the following cases:

The BCRAT is not an accurate tool for everyone. People with certain medical histories will need to use other risk assessment tools:

A person can consult a doctor to discuss their breast cancer risk. This is particularly important if they have:

  • a history of DCIS
  • a history of radiation therapy to the chest for Hodgkin’s lymphoma
  • history of breast cancer
  • an inherited breast cancer-causing syndrome

People may be able to reduce their risk of breast cancer by:

People with an increased risk of breast cancer may also consider the following:

  • genetic counseling to test for breast cancer risk
  • medications to reduce breast cancer risk
  • preventive breast or ovarian surgery
  • close monitoring, such as more frequent breast exams and earlier screening tests

Breast cancer resources

Visit our dedicated hub for more research-backed information and in-depth resources on breast cancer.

The BCRAT is a tool females can use to estimate their lifetime risk of developing invasive breast cancer.

A person answers a short questionnaire on medical and reproductive history to assess their breast cancer risk.

The BCRAT can estimate risk, but it cannot predict who will or will not develop breast cancer.