Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA.
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
Breast Cancer Res. 2018 Apr 18;20(1):33. doi: 10.1186/s13058-018-0943-9.
Younger age at onset of breast development, which has been declining in recent decades, is associated with increased breast cancer risk independent of age at menarche. Given the need to study the drivers of these trends, it is essential to validate methods to assess breast onset that can be used in large-scale studies when direct clinical assessment of breast onset is not feasible.
Breast development is usually measured by Tanner stages (TSs), assessed either by physical examination or by mother's report using a picture-based Sexual Maturation Scale (SMS). As an alternative, a mother-reported Pubertal Development Scale (PDS) without pictures has been used in some studies. We compared agreement of SMS and PDS with each other (n = 1022) and the accuracy of PDS with clinical TS as a gold standard for the subset of girls with this measure (n = 282) using the LEGACY cohort. We further compared prediction of breast onset using ROC curves and tested whether adding urinary estrone 1-glucuronide (E1G) improved the AUC.
The agreement of PDS with SMS was high (kappa = 0.80). The sensitivity of PDS vs clinical TS was 86.6%. The AUCs for PDS alone and SMS alone were 0.88 and 0.79, respectively. Including E1G concentrations improved the AUC for both methods (0.91 and 0.86 for PDS and SMS, respectively).
The PDS without pictures is a highly accurate, sensitive, and specific method for assessing breast onset, especially in settings where clinical TS is not feasible. In addition, it is comparable to SMS methods with pictures and thus easier to implement in large-scale studies, particularly phone-based interviews where pictures may not be available. Urinary E1G can improve accuracy over than PDS or SMS alone.
近年来，乳房发育起始年龄呈下降趋势，与乳腺癌风险增加有关，且这种关联独立于初潮年龄。鉴于需要研究这些趋势的驱动因素，因此必须验证能够在直接临床评估乳房起始不可行的情况下用于大规模研究的评估乳房起始的方法。
乳房发育通常通过 Tanner 分期（TS）来衡量，通过体格检查或使用基于图片的性成熟量表（SMS）由母亲报告来评估。作为替代方法，一些研究中使用了没有图片的基于母亲报告的青春期发育量表（PDS）。我们比较了 SMS 和 PDS 之间的一致性（n = 1022），并将 PDS 的准确性与临床 TS 进行了比较，将该方法应用于具有该指标的女孩亚组（n = 282），使用 LEGACY 队列。我们进一步通过 ROC 曲线比较了乳房起始的预测，并测试了是否添加尿液雌酮 1-葡糖苷酸（E1G）是否可以提高 AUC。
PDS 与 SMS 的一致性很高（kappa = 0.80）。PDS 与临床 TS 的灵敏度为 86.6％。PDS 与 SMS 单独使用的 AUC 分别为 0.88 和 0.79。同时包括 E1G 浓度可提高两种方法的 AUC（PDS 和 SMS 分别为 0.91 和 0.86）。
无图片的 PDS 是一种高度准确、敏感和特异的评估乳房起始的方法，尤其是在无法进行临床 TS 的情况下。此外，它与带有图片的 SMS 方法相当，因此更容易在大规模研究中实施，尤其是在没有图片的电话访谈中。尿液 E1G 可提高 PDS 或 SMS 单独使用的准确性。
