Medical Oncologist
CION Cancer Clinics
Tyrer-Cuzick, BOADICEA and Manchester: how risk models work | CION Cancer Clinics
Risk assessment models turn your family tree into an estimate. Some estimate the chance that your family carries an inherited fault. Others estimate your chance of breast cancer over time. Counsellors use them to decide who is tested and who needs extra screening. This page explains the three you are most likely to hear about, what each number means, and where the models fall short. At CION Cancer Clinics in Hyderabad, our oncologists review your family history with you and guide you to the right genetic counselling and testing.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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On this page
- What does a risk assessment model actually tell you?
- Tyrer-Cuzick, BOADICEA and Manchester: what each one does
- How does a counsellor use a model with your family?
- The words you will meet, in plain language
- Which model answers which question?
- What this page cannot tell you
- Four things families tell us, and what is actually true
- Common questions about cancer risk models
The short answer
What does a risk assessment model actually tell you?
A risk assessment model is a calculator that turns your family tree into a number. Some estimate the chance that you carry an inherited fault. Others estimate your chance of developing breast cancer over the next ten years or over your lifetime. Counsellors use them to decide who should be tested and who should be screened more closely.
Why a calculator, and not just a judgement
Two families can look equally worrying and carry very different risks. A mother diagnosed young counts for more than an aunt diagnosed late. An ovarian cancer counts for more than a second breast cancer. A model weighs all of this the same way every time, so the decision does not depend on which doctor you happened to see.
Why the three names keep coming up
Tyrer-Cuzick, BOADICEA and the Manchester score are the three most widely used for breast and ovarian cancer families. They were built for different jobs. Knowing which one was used tells you what question your number is actually answering.
A model gives an estimate for people like you. It does not know what will happen to you.The three models
Tyrer-Cuzick, BOADICEA and Manchester: what each one does
They overlap, but each was designed to answer a slightly different question. Counsellors often run more than one.
The Manchester score
A points table on paper. Each relative with breast, ovarian, prostate or pancreatic cancer adds points, more for a younger diagnosis. The total estimates the chance that the family carries a BRCA1 or BRCA2 fault.
Quick, needs no computer, and good at one question: is a BRCA test worth doing?BOADICEA
A computer model from Cambridge, now run through a tool called CanRisk. It uses the whole family tree, on both sides, with the ages of relatives who were never ill.
It estimates
- The chance of a fault in several breast cancer genes
- Breast and ovarian cancer risk over time
- How a test result changes that risk
Tyrer-Cuzick
Also called the IBIS model. It adds your own history to the family tree: when periods started and stopped, pregnancies, weight, hormone treatment and some earlier breast biopsy results. It is mainly used to decide who needs extra breast screening.
What none of them does
None of them diagnoses anything. None covers bowel, stomach or childhood cancer syndromes, which use different tools. And none replaces a counsellor checking that the family history fed into it is right.
Not sure whether this applies to you?
Ask an oncologistIn the appointment
How does a counsellor use a model with your family?
Your family tree is drawn
Every relative on both sides, living or dead, with any cancer and roughly how old they were. Relatives who never had cancer matter too, because their ages change the answer.
The diagnoses are checked
"A stomach problem" might have been ovarian cancer. Where possible, the counsellor confirms diagnoses from old reports, because one wrong entry can move the number a long way.
The details go into the model
For Tyrer-Cuzick or CanRisk, your own history is added. This takes a few minutes, and you may be asked questions that feel personal. They are asked for a reason.
The numbers are read together
The counsellor looks at the chance of carrying a fault and the chance of cancer. They explain what each number means for testing, screening and prevention, in plain language.
On your letter
The words you will meet, in plain language
- Carrier probability
- The estimated chance that you, or your family, carry an inherited fault in a particular gene. It is used to decide whether a test is worth doing.
- Lifetime risk
- The estimated chance of developing a cancer at some point in your life, usually counted up to old age.
- Ten-year risk
- The same estimate, over the next ten years only. It is often more useful for deciding what to do now.
- Pedigree
- The formal name for the family tree the counsellor draws. It is the raw material every model runs on.
- Polygenic risk score
- A number built from many small genetic differences, each with a tiny effect. Some newer versions of the models can add it in.
- Risk category
- A band such as average, moderate or high risk. Screening advice is usually tied to the band, not the exact figure.
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Side by side
Which model answers which question?
The question
The model most often used
Is a BRCA test worth doing in this family?
Manchester score, or BOADICEA
Which breast cancer gene is most likely involved?
BOADICEA, through CanRisk
Does this woman need extra breast screening?
Tyrer-Cuzick or BOADICEA
How has a negative test changed her risk?
BOADICEA, which can use test results
Being straight with you
What this page cannot tell you
It cannot calculate your risk. A model is only as good as the family history fed into it, and taking that history properly is the counsellor's job. Online versions exist, but a number you produce on your own, without the checking, can alarm you or reassure you wrongly.
How well the models fit Indian families
All three were built mainly on families in Britain, Europe and North America. Breast cancer in India is often diagnosed younger, and family records are often incomplete. Studies testing these models in Indian women so far are small. Counsellors here use them as a guide and lean on judgement alongside the number.
Who this does not apply to
If a fault has already been found in you, you do not need a model to guess whether you carry one. Your risk comes from the gene itself. These models also say little about bowel or other cancers. And most people with one older relative with breast cancer will land in the average band.
What your specific numbers mean is a question for the counsellor who ran the model.Commonly believed
Four things families tell us, and what is actually true
"The model said high risk, so I will get cancer."
A high-risk band means your chance is raised compared with other women, not that cancer is expected. Most women in a high band never develop breast cancer. The label exists to decide screening.
"A low score means I do not need to worry at all."
A low score means an inherited fault is unlikely. It does not remove the ordinary risk every woman carries, so routine breast checks for your age still apply.
"My father's side does not count."
Every model uses both sides. A fault can pass through a father who never had cancer, so his mother, sisters and cousins belong on the tree.
"The different models gave different numbers, so one is wrong."
They answer different questions and use different details, so their numbers are not meant to match. The counsellor explains which one matters for your decision.
Questions we are asked
Common questions about cancer risk models
Can I run one of these models myself online?
Some are available online, but the number is only as good as the family history you enter. Counsellors spend time checking diagnoses and ages before they trust the result. Treat anything you calculate alone as a reason to ask, not as an answer.
Which model will my counsellor use?
It depends on the question. For deciding whether a BRCA test is worth doing, a quick score or BOADICEA is common. For deciding on extra breast screening, Tyrer-Cuzick or BOADICEA is more usual. Many counsellors run two and compare.
Why does my counsellor need to know about my periods and pregnancies?
Hormonal history changes breast cancer risk a little, so models like Tyrer-Cuzick include it. Your answers stay confidential. If a question feels uncomfortable, you can ask why it matters before answering.
Do these models work for men?
They count men in the family, including male breast and prostate cancer, because men pass on faults too. The cancer risk they report is mainly for women. A man's own risk is usually judged from his family history and, if needed, a test.
What if I do not know what my grandparents died of?
That is common, and the counsellor will record it as unknown rather than guess. Gaps make the estimate less certain. Ask older relatives, and look for old hospital papers or death certificates if the family kept them.
Will my number change over time?
Yes. A new diagnosis in the family, a test result or simply getting older can change it. Tell your counsellor or doctor if anyone new in the family is diagnosed, so they can recalculate.
Does a high score mean I will be offered surgery?
No. A high score usually leads to a genetic test or extra screening first. Preventive surgery is discussed only in particular situations, as one option among several, and always after proper counselling.
Where do I start?
Write down every relative on both sides who had cancer, with the type and roughly their age. Take that list to a genetic counsellor or your oncologist and ask whether a risk assessment makes sense. Call the CION helpline if you are not sure who to see.
Your Specialists
Meet CION's oncologists. Bring your family history or genetic report to them.
Our medical oncologists see people with a strong family history of cancer, arrange genetic counselling and testing where it fits, and plan the checks that follow.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
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Sources
- NICE — Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer (CG164)
- National Cancer Institute — Genetics of Breast and Gynecologic Cancers (PDQ) – Health Professional Version
- Cancer Research UK — Inherited cancer genes and increased cancer risk
- University of Cambridge — CanRisk
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
How your risk is calculatedWhat the counsellor does with your family tree, step by stepWhat a lifetime risk percentage actually meansHow to read the number a model gives youBuilding your family tree before the appointmentThe model is only as good as the tree you bringTesting criteria explained without the jargonWhen a family qualifies for testing without any model at all
Talk to us
Wondering whether your family history needs a proper risk assessment?
Tell us who in your family was diagnosed and at what age. We will tell you honestly whether a genetic counselling referral makes sense, and arrange it if it does. One helpline serves every CION centre.