Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, MO 64108, USA.
Menopause. 2011 Jun;18(6):621-4. doi: 10.1097/gme.0b013e3182027963.
The aim of this study was to evaluate the practical usefulness of family history as a tool for breast cancer risk assessment.
Women from the Raloxifene Use for The Heart trial (N = 10,048), which consisted of postmenopausal women with or at high risk for coronary artery disease, were included in this post hoc analysis. The breast cancer risk score at baseline was calculated using the National Cancer Institute's Breast Cancer Risk Assessment tool. The positive predictive value of family history as a predictor of risk was determined for several risk thresholds.
Almost all (99.6%) women with a family history of breast cancer are found to be at high risk using the National Cancer Institute's accepted cutoff point of at least 1.66%, and almost 98% of women with a family history of breast cancer belong to the high-risk group when the cutoff point for risk score is 2%.
Family history alone as a high-risk predictor is associated with a high positive predictive value at commonly used cutoff points based on the risk estimates from the traditional Gail model. Although more complex models of breast cancer risk should still be used as the standard for assessment, screening using family history seems to be a first step in beginning the discussion with women.
本研究旨在评估家族史作为乳腺癌风险评估工具的实际效用。
本研究纳入了瑞洛昔芬用于心脏试验（N=10048）中的女性，该试验由患有或有高冠状动脉疾病风险的绝经后女性组成。在该试验中，使用国家癌症研究所的乳腺癌风险评估工具计算了基线时的乳腺癌风险评分。确定了家族史作为风险预测因子的阳性预测值，用于几个风险阈值。
几乎所有（99.6%）有乳腺癌家族史的女性，按照国家癌症研究所接受的至少 1.66%的截止点，都被认为是高风险人群，当风险评分的截止点为 2%时，几乎 98%的有乳腺癌家族史的女性都属于高风险人群。
仅家族史作为高风险预测因子，与基于传统 Gail 模型的风险估计的常用截止点相关，具有较高的阳性预测值。尽管更复杂的乳腺癌风险模型仍应作为评估的标准，但使用家族史进行筛查似乎是与女性开始讨论的第一步。
