Department of Surgery, Dankook University College of Medicine, Cheonan, Korea.
Department of Surgery, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Korea.
J Breast Cancer. 2014 Sep;17(3):226-35. doi: 10.4048/jbc.2014.17.3.226. Epub 2014 Sep 30.
The Gail model is one of the most widely used tools to assess the risk of breast cancer. However, it is known to overestimate breast cancer risk for Asian women. Here, we validate the Gail model and the Korean model using Korean data, and subsequently update and revalidate the Korean model using recent data.
We validated the modified Gail model (model 2), Asian American Gail model, and a previous Korean model using screening patient data collected between January 1999 and July 2004. The occurrence of breast cancer was confirmed by matching the resident registration number with data from the Korean Breast Cancer Registration Program. The expected-to-observed (E/O) ratio was used to validate the reliability of the program, and receiver operating characteristics curve analysis was used to evaluate the program's discriminatory power. There has been a rapid increase in the incidence of breast cancer in Korea, and we updated and revalidated the Korean model using incidence and mortality rate data from recent years.
Among 40,229 patients who were included in the validation, 161 patients were confirmed to have developed breast cancer within 5 years of screening. The E/O ratios and 95% confidence intervals (CI) were 2.46 (2.10-2.87) for the modified Gail model and 1.29 (1.11-1.51) for the Asian American Gail model. The E/O ratio and 95% CI for the Korean model was 0.50 (0.43-0.59). For the updated Korean model, the E/O ratio and 95% CI were 0.85 (0.73-1.00). In the discriminatory power, the area under curve and 95% CI of the modified Gail model, Asian American Gail model, Korean model and updated Korean model were 0.547 (0.500-0.594), 0.543 (0.495-0.590), 0.509 (0.463-0.556), and 0.558 (0.511-0.605), respectively.
The updated Korean model shows a better performance than the other three models. It is hoped that this study can provide the basis for a clinical risk assessment program and a future prospective study of breast cancer prevention.
盖尔模型是评估乳腺癌风险最广泛使用的工具之一。然而，它被认为对亚裔女性的乳腺癌风险估计过高。在这里，我们使用韩国数据验证了盖尔模型和韩国模型，随后使用最近的数据更新和重新验证了韩国模型。
我们使用 1999 年 1 月至 2004 年 7 月期间收集的筛查患者数据验证了改良盖尔模型（模型 2）、亚裔美国人盖尔模型和以前的韩国模型。通过与韩国乳腺癌登记计划的数据相匹配来确认乳腺癌的发生。使用期望与观察（E/O）比值来验证程序的可靠性，并使用接收者操作特征曲线分析来评估程序的区分能力。韩国的乳腺癌发病率迅速上升，我们使用近年来的发病率和死亡率数据更新和重新验证了韩国模型。
在纳入验证的 40229 例患者中，有 161 例患者在筛查后 5 年内被确诊患有乳腺癌。改良盖尔模型的 E/O 比值和 95%置信区间（CI）为 2.46（2.10-2.87），亚裔美国人盖尔模型为 1.29（1.11-1.51）。韩国模型的 E/O 比值和 95%CI 为 0.50（0.43-0.59）。对于更新后的韩国模型，E/O 比值和 95%CI 为 0.85（0.73-1.00）。在区分能力方面，改良盖尔模型、亚裔美国人盖尔模型、韩国模型和更新后的韩国模型的曲线下面积和 95%CI 分别为 0.547（0.500-0.594）、0.543（0.495-0.590）、0.509（0.463-0.556）和 0.558（0.511-0.605）。
更新后的韩国模型表现优于其他三个模型。希望本研究能够为临床风险评估计划和未来的乳腺癌预防前瞻性研究提供依据。
