A Validated Risk Prediction Model for Breast Cancer in US Black Women

Author:

Palmer Julie R.12ORCID,Zirpoli Gary1ORCID,Bertrand Kimberly A.12ORCID,Battaglia Tracy2,Bernstein Leslie3ORCID,Ambrosone Christine B.4ORCID,Bandera Elisa V.5ORCID,Troester Melissa A.6ORCID,Rosenberg Lynn1,Pfeiffer Ruth M.7ORCID,Trinquart Ludovic8

Affiliation:

1. Slone Epidemiology Center at Boston University, Boston, MA

2. Boston University School of Medicine, Boston, MA

3. City of Hope Comprehensive Cancer Center, Duarte, CA

4. Roswell Park Comprehensive Cancer Center, Buffalo, NY

5. Rutgers Cancer Institute of New Jersey, New Brunswick, NJ

6. University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC

7. National Cancer Institute, Division of Cancer Epidemiology and Genetics, Bethesda, MD

8. Boston University School of Public Health, Boston, MA

Abstract

PURPOSE Breast cancer risk prediction models are used to identify high-risk women for early detection, targeted interventions, and enrollment into prevention trials. We sought to develop and evaluate a risk prediction model for breast cancer in US Black women, suitable for use in primary care settings. METHODS Breast cancer relative risks and attributable risks were estimated using data from Black women in three US population-based case-control studies (3,468 breast cancer cases; 3,578 controls age 30-69 years) and combined with SEER age- and race-specific incidence rates, with incorporation of competing mortality, to develop an absolute risk model. The model was validated in prospective data among 51,798 participants of the Black Women's Health Study, including 1,515 who developed invasive breast cancer. A second risk prediction model was developed on the basis of estrogen receptor (ER)–specific relative risks and attributable risks. Model performance was assessed by calibration (expected/observed cases) and discriminatory accuracy (C-statistic). RESULTS The expected/observed ratio was 1.01 (95% CI, 0.95 to 1.07). Age-adjusted C-statistics were 0.58 (95% CI, 0.56 to 0.59) overall and 0.63 (95% CI, 0.58 to 0.68) among women younger than 40 years. These measures were almost identical in the model based on estrogen receptor–specific relative risks and attributable risks. CONCLUSION Discriminatory accuracy of the new model was similar to that of the most frequently used questionnaire-based breast cancer risk prediction models in White women, suggesting that effective risk stratification for Black women is now possible. This model may be especially valuable for risk stratification of young Black women, who are below the ages at which breast cancer screening is typically begun.

Publisher

American Society of Clinical Oncology (ASCO)

Subject

Cancer Research,Oncology

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