BAN, RN, IBCLC
Last month, actress Olivia Munn, 43, announced that she had been diagnosed with breast cancer and received a double mastectomy. Munn is the partner of comedian John Mulaney, with whom they share a 2-year-old son. Celebrity health updates such as this can influence public opinion due to their popularity and ability to reach a broad audience. They also can entice people to take control of their health and make positive lifestyle changes.
One out of every eight people assigned female at birth (AFAB) will face a breast cancer diagnosis in their lifetime. Learn more below about Munn’s breast cancer story, as well as the specific screening tool that helped save her life.
In her announcement, Olivia Munn referenced a specific screening calculator called the Breast Cancer Risk Assessment Tool (BCRAT), otherwise known as the Gail Model. This tool exists online via the National Cancer Institute (NCI) website. It is easy for patients to complete in about five minutes alongside their healthcare provider. The screening tool assesses a person’s lifetime risk of testing positive for breast cancer:
According to Munn, she scored high on the BCRAT – a lifetime cancer risk of 37%. This, in turn, prompted her to pursue targeted testing and imagery she otherwise might not have received. The next step of MRI and subsequent ultrasound and biopsy led to Munn’s diagnosis of an aggressive form of breast cancer called Luminal B. An intensive 10-month treatment began for Munn, resulting in four surgeries and a double mastectomy.
Of particular significance, Munn reported having recently passed her routine mammography screening and cancer gene testing.
“My sister Sara had just tested negative [for cancer genes] as well,” she stated, “We called each other and high-fived over the phone. That same winter, I had a normal mammogram. Two months later, I was diagnosed with breast cancer.”
The genetic test Munn initially received checked for 90 cancer genes.
Munn advocated for her own doctor’s recommendation that anyone with a Breast Cancer Risk Assessment Score more significant than 20% should make a plan with their doctor and receive an annual MRI and mammogram beginning at age 30. She credits her doctor’s proactive decision to calculate her risk score as pivotal – “The fact that she did save my life.”
With this information in mind, why doesn’t everybody complete the BCRAT to determine their breast cancer risk score? Some evidence shows that the BCRAT might not provide complete or accurate data for all demographics.
For example, it was originally developed in 1989 based on data only from white women. However, the algorithm has been updated to increase screening accuracy in women of Black, Hispanic, Asian, and Pacific Islander descent. The NCI stated that it could underestimate risk in Hispanic women born outside the U.S. and in Black women with previous biopsies. The site suggests that more research is needed to validate risk in various subgroups.
In addition, while the BCRAT tends to under-represent risk, a standard screening counterpart used by healthcare providers called the International Breast Cancer Identification Study (IBIS) tends to over-represent risk. Doctors may balance both screens to identify at-risk patients.
The BCRAT also may not be the ideal tool for patients with a history of the following medical conditions:
The National Comprehensive Cancer Network (NCCN) contains valuable resources for patients and caregivers about various cancer-related topics and screening options. Other breast cancer screening tools also exist beyond the BCRAT risk calculator, although enough evidence may not exist to say definitively which resource is best.
Available tools or strategies include:
Having accurate screening tools ensures the right people receive referrals for additional testing. The existing limitations of specific diagnostic modalities further highlight this importance. In addition to genetic considerations, the NCI discusses in greater detail the benefits and harms of various additional breast cancer assessment and diagnostic methods:
Of note is that the majority of those who get breast cancer do not have a genetic predisposition.
“Only 5 to 10% of people who get breast cancer have a gene that tests positive,” Joann Mortimer, MD, medical oncologist, and Women’s Cancers Program director, said.
Also, 17% to 43% of women with cancer have a falsely negative clinical breast examination (CBE). Finally, breast self-examination (BSE) has been found to have no definitive reduction in mortality compared to no BSE.
Keep in mind that tests like mammography are imperfect. Essential mammograms tend to miss tumors in dense breast tissue. Women with dense breast tissue – about half of women older than 40 – have a higher proportion of glandular and fibrous tissue, making it harder to identify the cancer. Essential mammography screening can cause false negatives due to invasive breast cancers being undetected in 6% to 46% of cases.
On the other hand, routine mammography screening results in 10% of women being recalled for further testing. These false positives can cause unnecessary anxiety and testing.
Nurses can advocate for preventive and proactive healthcare, including awareness of cancer screening resources. According to a Gallup ethics poll, in 2023, nurses earned the topmost trusted spot of surveyed professions for the 22nd year. The general public consistently trusts nurses more than any other profession.
Often, they also count on nurses to be aware of trends in public health issues and the diagnosis and treatment of illnesses. Nurses can also point friends, family members, or patients to their doctors for these complex discussions.
Following Munn’s announcement, an NCI spokesperson claims visits to the BCRAT tool website have increased dramatically. What does this heightened awareness surrounding cancer risk tools mean for nurses, patients, and the public? Understanding the accuracy of existing information and recommendations is crucial. Unfortunately, even following routine physician-recommended cancer screenings may not always result in a timely or accurate breast cancer diagnosis.
A more proactive and multifaceted approach is sometimes needed. Munn’s experience sheds light on the need for additional screening action and further research into existing methods to increase effectiveness across all demographics.
Stories like Olivia Munn’s function as a “call to action” for society. We must take a step back and widen our lens as we explore who is at risk for certain cancers and who is not. This challenge provides both the public and the healthcare community with the agency. Dr. Sagar Sardesai, MD, MPH, states, “Early detection is key as the chances of a cure in women with early-stage breast cancer are very high.”
Munn’s story also provides much-needed hope for those who might feel anxiety upon hearing about her cancer experience.
“I’m lucky. We caught it with enough time that I had options… I want the same for any woman who might face this one day.” Munn shared on Instagram: “I was diagnosed with breast cancer. I hope sharing this will help others find comfort, inspiration, and support in their journey.”
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