The evolution of breast cancer risk assessment.

Breast cancer risk assessment is in the process of refinement, largely due to the potential for pharmacologic risk reduction. In the 1970s, benign tissue changes were assigned relative risk (RR) values. The 1980s witnessed the introduction of mathematical models for calculating risk. Genetic counseling and testing appeared in the 1990s. Now in 2002, we are witnessing efforts to improve risk assessment by actively searching for cellular 'atypia' through nipple aspirate fluid (NAF), ductal lavage, and random fine needle aspiration (FNA). One deficiency plagues any approach to predicting breast cancer based on historical risk factors--exclusion of the 70% majority of women who develop breast cancer without any identifiable risk factors. Realizing that the long-term goal of breast cancer risk assessment should be tissue and/or serum-based strategies, the authors introduce the Oklahoma Breast Cancer Project, a tissue bank designed to augment research devoted to molecular biologic markers of risk.