Boggs Deborah A, Rosenberg Lynn, Adams-Campbell Lucile L, Palmer Julie R
Deborah A. Boggs, Lynn Rosenberg, and Julie R. Palmer, Slone Epidemiology Center at Boston University, Boston, MA; and Lucile L. Adams-Campbell, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
J Clin Oncol. 2015 Mar 20;33(9):1038-44. doi: 10.1200/JCO.2014.57.2750. Epub 2015 Jan 26.
Breast cancer risk prediction models have underestimated risk for African American women, contributing to lower recruitment rates in prevention trials. A model previously developed for African American women was found to underestimate risk in the Black Women's Health Study (BWHS).
We developed a breast cancer risk model for African American women using relative risks derived from 10 years of follow-up of BWHS participants age 30 to 69 years at baseline. Using the subsequent 5 years of follow-up data, we evaluated calibration as the ratio of expected to observed number of breast cancers and assessed discriminatory accuracy using the concordance statistic.
The BWHS model included family history, previous biopsy, body mass index at age 18 years, age at menarche, age at first birth, oral contraceptive use, bilateral oophorectomy, estrogen plus progestin use, and height. There was good agreement between predicted and observed number of breast cancers overall (expected-to-observed ratio, 0.96; 95% CI, 0.88 to 1.05) and in most risk factor categories. Discriminatory accuracy was higher for women younger than age 50 years (area under the curve [AUC], 0.62; 95% CI, 0.58 to 0.65) than for women age ≥ 50 years (AUC, 0.56; 95% CI, 0.53 to 0.59). Using a 5-year predicted risk of 1.66% or greater as a cut point, 2.8% of women younger than 50 years old and 32.2% of women ≥ 50 years old were classified as being at elevated risk of invasive breast cancer.
The BWHS model was well calibrated overall, and the predictive ability was best for younger women. The proportion of women predicted to meet the 1.66% cut point commonly used to determine eligibility for breast cancer prevention trials was greatly increased relative to previous models.
乳腺癌风险预测模型低估了非裔美国女性的风险，导致预防试验中的招募率较低。此前为非裔美国女性开发的一个模型在黑人女性健康研究（BWHS）中被发现低估了风险。
我们利用基线时年龄在30至69岁的BWHS参与者10年随访得出的相对风险，为非裔美国女性开发了一个乳腺癌风险模型。利用随后5年的随访数据，我们将校准评估为预期乳腺癌病例数与观察到的乳腺癌病例数之比，并使用一致性统计量评估判别准确性。
BWHS模型包括家族史、既往活检、18岁时的体重指数、初潮年龄、首次生育年龄、口服避孕药使用情况、双侧卵巢切除术、雌激素加孕激素使用情况以及身高。总体而言，预测的和观察到的乳腺癌病例数之间有良好的一致性（预期与观察之比为0.96；95%可信区间为0.88至1.05），并且在大多数风险因素类别中也是如此。50岁以下女性的判别准确性（曲线下面积[AUC]为0.62；95%可信区间为0.58至0.65）高于50岁及以上女性（AUC为0.56；95%可信区间为0.53至0.59）。以5年预测风险1.66%或更高作为切点，50岁以下女性中有2.8%、50岁及以上女性中有32.2%被归类为浸润性乳腺癌风险升高。
BWHS模型总体校准良好，对年轻女性的预测能力最佳。相对于之前的模型，预计达到通常用于确定乳腺癌预防试验资格的1.66%切点的女性比例大幅增加。
