Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.
Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Victoria, Australia.
J Natl Cancer Inst. 2021 Jun 1;113(6):785-791. doi: 10.1093/jnci/djaa178.
Clinical guidelines often use predicted lifetime risk from birth to define criteria for making decisions regarding breast cancer screening rather than thresholds based on absolute 5-year risk from current age.
We used the Prospective Family Cohort Study of 14 657 women without breast cancer at baseline in which, during a median follow-up of 10 years, 482 women were diagnosed with invasive breast cancer. We examined the performances of the International Breast Cancer Intervention Study (IBIS) and Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) risk models when using the alternative thresholds by comparing predictions based on 5-year risk with those based on lifetime risk from birth and remaining lifetime risk. All statistical tests were 2-sided.
Using IBIS, the areas under the receiver-operating characteristic curves were 0.66 (95% confidence interval = 0.63 to 0.68) and 0.56 (95% confidence interval = 0.54 to 0.59) for 5-year and lifetime risks, respectively (Pdiff < .001). For equivalent sensitivities, the 5-year incidence almost always had higher specificities than lifetime risk from birth. For women aged 20-39 years, 5-year risk performed better than lifetime risk from birth. For women aged 40 years or older, receiver-operating characteristic curves were similar for 5-year and lifetime IBIS risk from birth. Classifications based on remaining lifetime risk were inferior to 5-year risk estimates. Results were similar using BOADICEA.
Our analysis shows that risk stratification using clinical models will likely be more accurate when based on predicted 5-year risk compared with risks based on predicted lifetime and remaining lifetime, particularly for women aged 20-39 years.
临床指南通常使用从出生到预测的终生风险来定义与乳腺癌筛查相关的决策标准，而不是基于当前年龄的绝对 5 年风险阈值。
我们使用前瞻性家族队列研究（14657 名基线时无乳腺癌的女性），中位随访 10 年期间，482 名女性被诊断为浸润性乳腺癌。我们通过比较基于 5 年风险的预测值与基于出生时终生风险和剩余终生风险的预测值，检查国际乳腺癌干预研究（IBIS）和乳腺癌与卵巢疾病发病和携带者估计算法（BOADICEA）风险模型在使用替代阈值时的性能。所有统计检验均为双侧检验。
使用 IBIS，5 年风险和终生风险的受试者工作特征曲线下面积分别为 0.66（95%置信区间=0.63 至 0.68）和 0.56（95%置信区间=0.54 至 0.59）（Pdiff<.001）。对于等效的敏感性，5 年发病率的特异性几乎总是高于出生时的终生风险。对于 20-39 岁的女性，5 年风险优于出生时的终生风险。对于 40 岁或以上的女性，5 年和出生时终生 IBIS 风险的受试者工作特征曲线相似。基于剩余终生风险的分类不如 5 年风险估计准确。使用 BOADICEA 得到的结果相似。
我们的分析表明，基于预测的 5 年风险对女性进行风险分层，其准确性可能高于基于预测的终生风险和剩余终生风险的风险分层，特别是对于 20-39 岁的女性。
