Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
Breast. 2013 Feb;22(1):83-8. doi: 10.1016/j.breast.2012.09.015. Epub 2012 Nov 7.
The Gail Model (GM) is the most well-known model to assess the individual risk of breast cancer (BC). Although its discriminatory accuracy is low in the clinical context, its usefulness in the screening setting is not well known. The aim of this study is to assess the utility of the GM in a European screening program.
Retrospective cohort study of 2200 reassessed women with information on the GM available in a BC screening program in Barcelona, Spain. The 5 year-risk of BC applying the GM right after the screening mammogram was compared first with the actual woman's risk of BC in the same screening round and second with the BC risk during the next 5 years.
The curves of BC Gail risk overlapped for women with and without BC, both in the same screening episode as well as 5 years afterward. Overall sensitivity and specificity in the same screening episode were 22.3 and 86.5%, respectively, and 46.2 and 72.1% 5 years afterward. ROC curves were barely over the diagonal and the concordance statistics were 0.59 and 0.61, respectively.
The GM has very low accuracy among women with a positive mammogram result, predicting BC both in the concomitant episode and 5 years later. Our results do not encourage the use of the GM in the screening context to aid the referral decision or the type of procedures after a positive mammogram or to identify women at high risk among those with a false-positive outcome.
Gail 模型（GM）是评估个体乳腺癌（BC）风险最知名的模型。尽管其在临床环境下的判别准确性较低，但在筛查环境中的效用尚不清楚。本研究旨在评估 GM 在欧洲筛查计划中的实用性。
对西班牙巴塞罗那 BC 筛查计划中 2200 名重新评估的女性进行回顾性队列研究，这些女性的 GM 信息可用。应用 GM 计算的 5 年 BC 风险首先与同一筛查轮次中实际女性的 BC 风险进行比较，其次与未来 5 年内的 BC 风险进行比较。
在同一筛查期和 5 年后，患有和未患有 BC 的女性的 BC Gail 风险曲线重叠。在同一筛查期内的总体敏感性和特异性分别为 22.3%和 86.5%，5 年后分别为 46.2%和 72.1%。ROC 曲线几乎在对角线以上，一致性统计分别为 0.59 和 0.61。
在阳性乳腺 X 线摄影结果的女性中，GM 的准确性非常低，可预测同期和 5 年后的 BC。我们的结果不鼓励在筛查环境中使用 GM 来辅助转诊决策或阳性乳腺 X 线摄影后采用的检查类型，也不鼓励在假阳性结果的女性中识别高风险人群。
