Kumar Naveen, Singh Vinit, Mehta Garima
Department of General Surgery, Rabindra Nath Tagore Medical College and Hospital, Udaipur, Rajasthan, India.
Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.
Tzu Chi Med J. 2020 Apr 10;32(4):362-366. doi: 10.4103/tcmj.tcmj_171_19. eCollection 2020 Oct-Dec.
Modified Gail Model is a noninvasive, easy to implement risk estimation tool for absolute breast cancer risk. It was developed with data collected from non African American females and further modified for African-American, the Hispanic, and Native American populations. The use of this model for population outside the US and European country is not yet validated. We evaluated the prevalent risk factors and the effectiveness of the Gail model for risk assessment in our local Indian population.
A retrospective analysis of a prospectively maintained database was conducted on patients treated between 2008 and 2013. Six hundred and fifty patients were included in each group. Six questions were taken as per the breast cancer risk assessment tool calculator. A value of over 1.67% was taken as a high risk for breast cancer development.
The mean age of the participant was 50 ± 21.3 years in cases and 41 ± 16.4 years in controls. Age and age at first childbirth >30 years were found to be significant and associated with increased risk of breast carcinoma, but the age at menarche, family history, previous breast biopsy, and atypical hyperplasia was no significant. The Gail model was assessed, and sensitivity was 10.30% and 96.30% specificity for our population. Positive and negative predictive values were 73.62% and 51.77%.
Our study concluded that the Gail model is not an appropriate risk assessment tool for the population in its present form. For the future application of this model, we need to perform a bigger study with a higher sample size representing a maximum number of local variabilities in the Indian population.
改良盖尔模型是一种用于评估乳腺癌绝对风险的非侵入性且易于实施的风险评估工具。它是基于非非裔美国女性收集的数据开发的，并针对非裔美国人、西班牙裔和美国原住民群体进行了进一步改良。该模型在美国和欧洲国家以外人群中的应用尚未得到验证。我们评估了印度当地人群中常见的风险因素以及盖尔模型在风险评估中的有效性。
对2008年至2013年期间接受治疗的患者进行了一项前瞻性维护数据库的回顾性分析。每组纳入650例患者。根据乳腺癌风险评估工具计算器提出六个问题。超过1.67%的值被视为乳腺癌发生的高风险。
病例组参与者的平均年龄为50±21.3岁，对照组为41±16.4岁。发现年龄和首次生育年龄>30岁具有显著性，且与乳腺癌风险增加相关，但初潮年龄、家族史、既往乳腺活检和非典型增生无显著性。对盖尔模型进行了评估，对我们的人群而言，敏感性为10.30%，特异性为96.30%。阳性和阴性预测值分别为73.62%和51.77%。
我们的研究得出结论，盖尔模型目前的形式不适用于该人群。对于该模型的未来应用，我们需要进行一项更大规模的研究，样本量更大，以代表印度人群中最大数量的局部变异性。
