Banegas Matthew P, John Esther M, Slattery Martha L, Gomez Scarlett Lin, Yu Mandi, LaCroix Andrea Z, Pee David, Chlebowski Rowan T, Hines Lisa M, Thompson Cynthia A, Gail Mitchell H
Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA.
Cancer Prevention Institute of California, Fremont, CA, USA.
J Natl Cancer Inst. 2016 Dec 20;109(2). doi: 10.1093/jnci/djw215. Print 2017 Feb.
There is no model to estimate absolute invasive breast cancer risk for Hispanic women.
The San Francisco Bay Area Breast Cancer Study (SFBCS) provided data on Hispanic breast cancer case patients (533 US-born, 553 foreign-born) and control participants (464 US-born, 947 foreign-born). These data yielded estimates of relative risk (RR) and attributable risk (AR) separately for US-born and foreign-born women. Nativity-specific absolute risks were estimated by combining RR and AR information with nativity-specific invasive breast cancer incidence and competing mortality rates from the California Cancer Registry and Surveillance, Epidemiology, and End Results program to develop the Hispanic risk model (HRM). In independent data, we assessed model calibration through observed/expected (O/E) ratios, and we estimated discriminatory accuracy with the area under the receiver operating characteristic curve (AUC) statistic.
The US-born HRM included age at first full-term pregnancy, biopsy for benign breast disease, and family history of breast cancer; the foreign-born HRM also included age at menarche. The HRM estimated lower risks than the National Cancer Institute's Breast Cancer Risk Assessment Tool (BCRAT) for US-born Hispanic women, but higher risks in foreign-born women. In independent data from the Women's Health Initiative, the HRM was well calibrated for US-born women (observed/expected [O/E] ratio = 1.07, 95% confidence interval [CI] = 0.81 to 1.40), but seemed to overestimate risk in foreign-born women (O/E ratio = 0.66, 95% CI = 0.41 to 1.07). The AUC was 0.564 (95% CI = 0.485 to 0.644) for US-born and 0.625 (95% CI = 0.487 to 0.764) for foreign-born women.
The HRM is the first absolute risk model that is based entirely on data specific to Hispanic women by nativity. Further studies in Hispanic women are warranted to evaluate its validity.
尚无用于估计西班牙裔女性浸润性乳腺癌绝对风险的模型。
旧金山湾区乳腺癌研究（SFBCS）提供了西班牙裔乳腺癌病例患者（533名美国出生，553名外国出生）和对照参与者（464名美国出生，947名外国出生）的数据。这些数据分别得出了美国出生和外国出生女性的相对风险（RR）和归因风险（AR）估计值。通过将RR和AR信息与加利福尼亚癌症登记处以及监测、流行病学和最终结果计划中特定出生地的浸润性乳腺癌发病率和竞争死亡率相结合，估计特定出生地的绝对风险，从而开发出西班牙裔风险模型（HRM）。在独立数据中，我们通过观察/预期（O/E）比值评估模型校准情况，并使用受试者工作特征曲线（AUC）统计量下的面积估计判别准确性。
美国出生的HRM包括首次足月妊娠年龄、乳腺良性疾病活检以及乳腺癌家族史；外国出生的HRM还包括初潮年龄。对于美国出生的西班牙裔女性，HRM估计的风险低于美国国立癌症研究所的乳腺癌风险评估工具（BCRAT），但对于外国出生的女性，HRM估计的风险更高。在来自妇女健康倡议的独立数据中，HRM对美国出生的女性校准良好（观察/预期[O/E]比值 = 1.07，95%置信区间[CI] = 0.81至1.40），但似乎高估了外国出生女性的风险（O/E比值 = 0.66，95% CI = 0.41至1.07）。美国出生女性的AUC为0.564（95% CI = 0.485至0.644），外国出生女性的AUC为0.625（95% CI = 0.487至0.764）。
HRM是首个完全基于按出生地划分的西班牙裔女性特定数据的绝对风险模型。有必要对西班牙裔女性进行进一步研究以评估其有效性。
