A simple online cancer test may have saved actress Olivia Munn’s life

In early 2023, actress Olivia Munn had her annual mammogram, and the results showed all was fine. She’d also recently tested negative for the BRCA cancer gene mutation — a precautionary measure because of family medical history related to two aunts and a grandmother who had developed breast cancer.

At her annual Pap smear appointment that March, her gynecologist asked if she knew her lifetime breast cancer risk score. When she didn’t, they quickly went through the public, online Tyrer-Cuzick risk assessment test. A result over 20 percent is considered high risk. Munn’s score was 37.3 percent.

Tumors were detected in both of her breasts, confirmed via biopsies as stage 1 invasive cancer. Over the next month, Munn, then 43 and the mother of a 1-year-old, went through four surgeries, including a double mastectomy, followed by medically induced menopause.

Munn, star of “X-Men Apocalypse,” “Magic Mike” and TV’s “Newsroom,” has been speaking out this year about her cancer journey to try to raise awareness of the simple Tyrer-Cuzick test that may have saved her life. Naomi Kalliath, DO, a breast surgeon with Cape Cod Healthcare, also thinks the online risk assessment can be a key tool for women to take proactive steps to detect cancer.

“It’s free, it’s easy, it takes maybe five minutes,” she said. “It’s good to know where you are on that risk calculator.”

While mammograms have been vital tests for so many — Dr. Kalliath calls them the “gold standard” — data shows they catch about 80 percent of cancers. The sensitivity of mammograms can vary greatly, so that percentage can sometimes be even lower, she said, particularly for women with dense breast tissue. So, as in Munn’s case, the online risk test could make a difference in alerting a woman to potential problems that a mammogram did not find.

The Tyrer-Cuzick test for breast and ovarian cancer takes into account personal, medical and family history to assess cancer risk. Questions cover menstruation, menopause, childbirth, prior breast biopsy, hormone therapy, and medical history of female family members of three generations.

Cape Cod Healthcare has a health risk assessment tool online, where women can learn their risk factors for breast cancer. A full Tyrer-Cuzick test can also be ordered by your physician.

While patients have come to Dr. Kalliath asking about double mastectomies after hearing Munn’s story, the surgeon said not many of her patients have previously heard of the Tyrer-Cuzick test. To combat that, Cape Cod Healthcare has tried to push knowledge of the test, particularly during October’s Breast Cancer Awareness Month — and offers the specific website access to it.

Valuable for Women on Cape Cod

There are other, similar online risk-assessment tests available, including the Gail model, but Dr. Kalliath says breast surgeons seem to agree that the Tyrer-Cuzick test is “pretty much our best risk calculator that we have to just look at someone’s overall lifetime risk of breast cancer.” A score of over 20 percent, she said, can qualify women for further tests, such as genetic testing or an MRI.

The test could be a particularly valuable tool for women on Cape Cod, where incidence of breast cancer has for decades been higher than the state and national averages, according to a Silent Spring Institute study and public comments since from the Massachusetts Breast Cancer Coalition. While no answers for that elevated rate have been determined, Dr. Kalliath notes the continuing concerns about PFAS chemicals potentially in water here and other environmental factors.

Overall, though, Dr. Kalliath said, “our biggest risk factor as a whole for developing breast cancer for most people is simply being a female.” About 1 in 8 U.S. women are expected to develop breast cancer in their lifetime, and the number is slightly higher for Cape Cod.

In the U.S., the American Cancer Society has declared breast cancer the most common cancer in women, aside from skin cancers, accounting for about 30 percent of all new female cancers each year. In 2024, the society expects to see 310,720 new cases of invasive breast cancer in women in the United States, and 56,500 new cases of ductal carcinoma in situ (DCIS). An estimated 42,250 women are expected to die from breast cancer in 2024.

The Tyler-Cuzick test is one that women of any age can — and, according to Dr. Kalliath, should — take. She’s seen four or five women in their 30s in the past couple of months with breast cancer, and one in six breast cancers are diagnosed in women in their 40s, like Munn.

One caution from Munn’s story that Dr. Kalliath gives is the number of patients who ask about a similar double mastectomy, when such a radical choice isn’t necessarily required in many cases. Some patients have misconceptions about how cancer can develop elsewhere in the body, she said, and lumpectomies or single mastectomies can be options, too, for women who don’t have the BRCA1 or BRCA2 gene mutation that signals a likelihood for cancer.

Other Ways to Take Control

The Tyrer-Cusick test is just one of several steps Dr. Kalliath recommends women take to assert some understanding and control over their cancer risks. Healthy lifestyle habits are a vital tool to reducing the chances of developing breast cancer, or of cancer returning. Women should also:

• Maintain a healthy body weight
• Minimize alcohol intake
• Avoid tobacco and, most importantly
• Exercise regularly

“I tell people all the time that if you don’t do anything else, exercise is the one thing that is so important,” she said. “Data shows that exercising five days a week, just 20 to 30 minutes for each of those days, with one day of some sort of resistance – that reduces the breast cancer risk by 30 to 35 percent, which is huge.”

Women should also be mindful to have what Dr. Kalliath calls “self-breast awareness,” a recommendation she said medical societies have largely chosen to replace the longtime push for women to do regular self-breast exams. That change was made in part, she said, because most women have some lumps in their breasts, and experts want women to focus on more than just those.

“Knowing what your lumps feel like is a very important thing,” she said. “And checking for symmetry. Does this look and feel like a kind of mirror image to the other side? Is it something new? Is it different? Do you have any clear or bloody fluid coming from the nipple? All of these things would be potentially concerning.”

Taking the risk-assessment test, being aware of your breasts, and fostering healthy lifestyle habits are all ways women can reduce their possibility of getting breast cancer. “It’s not just, ‘Oh, well, here’s fate, and there’s nothing you can do about it,’” Dr. Kalliath says. “It’s great to know there’s something in your control.”