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Pegington M, Hawkes RE, Davies A, Mueller J, Howell A, Gareth Evans D, Howell SJ, French DP, Harvie M. An app promoting weight gain prevention via healthy behaviours amongst young women with a family history of breast cancer: Acceptability and usability assessment. J Hum Nutr Diet 2024. [PMID: 39004937 DOI: 10.1111/jhn.13347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Breast cancer is the most frequent female malignancy in the UK. Around 20% of cases are linked to weight gain, excess weight and health behaviours. We designed a weight gain prevention, health behaviour intervention for young women at increased risk. METHODS The study comprised a single arm observational study over 2 months testing acceptability and usability of the intervention: online group welcome event, app and private Facebook group. Females aged 18-35 years at moderate or high risk of breast cancer (>17% lifetime risk) were recruited via invite letters and social media posts. The app included behaviour change techniques and education content. Online questionnaires were completed at baseline, as well as at 1 and 2 months. We also assessed feasibility of study procedures. RESULTS Both recruitment methods were successful. Thirty-five women were recruited, 26% via social media posts. Median age was 33 (interquartile range = 28.2-34.5) years, the majority (94.1%) were of White ethnicity. Thirty-four participants were included in the analyses, of which 94% downloaded the app. Median self-monitoring logs per participant during the study period was 10.0 (interquartile range = 4.8-28.8). App quality mean (SD) score was 3.7 (0.6) at 1 and 2 months (scale: 1-5). Eighty-nine per cent rated the app at average or above at 1 month and 75.0% at 2 months. Nineteen women (55.9%) joined the Facebook group and there were 61 comments and 83 reactions and votes from participants during the study period. CONCLUSIONS This first iteration of the app and intervention was well received and is suitable to progress to the next stage of refining and further testing.
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Affiliation(s)
- Mary Pegington
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rhiannon E Hawkes
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | - Alan Davies
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Anthony Howell
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
| | - D Gareth Evans
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
- Genomic Medicine, Division of Evolution, Infection and Genomic Sciences, The University of Manchester, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sacha J Howell
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Michelle Harvie
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
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Collister JA, Liu X, Littlejohns TJ, Cuzick J, Clifton L, Hunter DJ. Assessing the Value of Incorporating a Polygenic Risk Score with Nongenetic Factors for Predicting Breast Cancer Diagnosis in the UK Biobank. Cancer Epidemiol Biomarkers Prev 2024; 33:812-820. [PMID: 38630597 PMCID: PMC11145162 DOI: 10.1158/1055-9965.epi-23-1432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/13/2024] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Previous studies have demonstrated that incorporating a polygenic risk score (PRS) to existing risk prediction models for breast cancer improves model fit, but to determine its clinical utility the impact on risk categorization needs to be established. We add a PRS to two well-established models and quantify the difference in classification using the net reclassification improvement (NRI). METHODS We analyzed data from 126,490 post-menopausal women of "White British" ancestry, aged 40 to 69 years at baseline from the UK Biobank prospective cohort. The breast cancer outcome was derived from linked registry data and hospital records. We combined a PRS for breast cancer with 10-year risk scores from the Tyrer-Cuzick and Gail models, and compared these to the risk scores from the models using phenotypic variables alone. We report metrics of discrimination and classification, and consider the importance of the risk threshold selected. RESULTS The Harrell's C statistic of the 10-year risk from the Tyrer-Cuzick and Gail models was 0.57 and 0.54, respectively, increasing to 0.67 when the PRS was included. Inclusion of the PRS gave a positive NRI for cases in both models [0.080 (95% confidence interval (CI), 0.053-0.104) and 0.051 (95% CI, 0.030-0.073), respectively], with negligible impact on controls. CONCLUSIONS The addition of a PRS for breast cancer to the well-established Tyrer-Cuzick and Gail models provides a substantial improvement in the prediction accuracy and risk stratification. IMPACT These findings could have important implications for the ongoing discussion about the value of PRS in risk prediction models and screening.
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Affiliation(s)
- Jennifer A. Collister
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Xiaonan Liu
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Thomas J. Littlejohns
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jack Cuzick
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Lei Clifton
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - David J. Hunter
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
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Stan DL, Kim JO, Schaid DJ, Carlson EE, Kim CA, Sinnwell JP, Couch FJ, Vachon CM, Cooke AL, Goldenberg BA, Pruthi S. Breast Cancer Polygenic-Risk Score Influence on Risk-Reducing Endocrine Therapy Use: Genetic Risk Estimate (GENRE) Trial 1-Year and 2-Year Follow-Up. Cancer Prev Res (Phila) 2024; 17:77-84. [PMID: 38154464 DOI: 10.1158/1940-6207.capr-23-0256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/26/2023] [Accepted: 12/21/2023] [Indexed: 12/30/2023]
Abstract
Refinement of breast cancer risk estimates with a polygenic-risk score (PRS) may improve uptake of risk-reducing endocrine therapy (ET). A previous clinical trial assessed the influence of adding a PRS to traditional risk estimates on ET use. We stratified participants according to PRS-refined breast cancer risk and evaluated ET use and ET-related quality of life (QOL) at 1-year (previously reported) and 2-year follow-ups. Of 151 participants, 58 (38.4%) initiated ET, and 22 (14.6%) discontinued ET by 2 years; 42 (27.8%) and 36 (23.8%) participants were using ET at 1- and 2-year follow-ups, respectively. At the 2-year follow-up, 39% of participants with a lifetime breast cancer risk of 40.1% to 100.0%, 18% with a 20.1% to 40.0% risk, and 16% with a 0.0% to 20.0% risk were taking ET (overall P = 0.01). Moreover, 40% of participants whose breast cancer risk increased by 10% or greater with addition of the PRS to a traditional breast cancer-risk model were taking ET versus 0% whose risk decreased by 10% or greater (P = 0.004). QOL was similar for participants taking or not taking ET at 1- and 2-year follow-ups, although most who discontinued ET did so because of adverse effects. However, these QOL results may have been skewed by the long interval between QOL surveys and lack of baseline QOL data. PRS-informed breast cancer prevention counseling has a lasting, but waning, effect over time. Additional follow-up studies are needed to address the effect of PRS on ET adherence, ET-related QOL, supplemental breast cancer screening, and other risk-reducing behaviors. PREVENTION RELEVANCE Risk-reducing medications for breast cancer are considerably underused. Informing women at risk with precise and individualized risk assessment tools may substantially affect the incidence of breast cancer. In our study, a risk assessment tool (IBIS-polygenic-risk score) yielded promising results, with 39% of women at highest risk starting preventive medication.
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Affiliation(s)
- Daniela L Stan
- Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Cancer Center, Mayo Clinic, Rochester, Minnesota
| | - Julian O Kim
- Department of Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Daniel J Schaid
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Erin E Carlson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Christina A Kim
- Department of Medical Oncology and Hematology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason P Sinnwell
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Fergus J Couch
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Celine M Vachon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Andrew L Cooke
- Department of Radiation Oncology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Benjamin A Goldenberg
- Department of Medical Oncology and Hematology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sandhya Pruthi
- Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic Cancer Center, Mayo Clinic, Rochester, Minnesota
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Mbuya-Bienge C, Pashayan N, Kazemali CD, Lapointe J, Simard J, Nabi H. A Systematic Review and Critical Assessment of Breast Cancer Risk Prediction Tools Incorporating a Polygenic Risk Score for the General Population. Cancers (Basel) 2023; 15:5380. [PMID: 38001640 PMCID: PMC10670420 DOI: 10.3390/cancers15225380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/26/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Single nucleotide polymorphisms (SNPs) in the form of a polygenic risk score (PRS) have emerged as a promising factor that could improve the predictive performance of breast cancer (BC) risk prediction tools. This study aims to appraise and critically assess the current evidence on these tools. Studies were identified using Medline, EMBASE and the Cochrane Library up to November 2022 and were included if they described the development and/ or validation of a BC risk prediction model using a PRS for women of the general population and if they reported a measure of predictive performance. We identified 37 articles, of which 29 combined genetic and non-genetic risk factors using seven different risk prediction tools. Most models (55.0%) were developed on populations from European ancestry and performed better than those developed on populations from other ancestry groups. Regardless of the number of SNPs in each PRS, models combining a PRS with genetic and non-genetic risk factors generally had better discriminatory accuracy (AUC from 0.52 to 0.77) than those using a PRS alone (AUC from 0.48 to 0.68). The overall risk of bias was considered low in most studies. BC risk prediction tools combining a PRS with genetic and non-genetic risk factors provided better discriminative accuracy than either used alone. Further studies are needed to cross-compare their clinical utility and readiness for implementation in public health practices.
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Affiliation(s)
- Cynthia Mbuya-Bienge
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada; (C.M.-B.); (C.D.K.)
- Oncology Division, CHU de Québec-Université Laval Research Center, Quebec City, QC G1S 4L8, Canada;
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London WC1E 6BT, UK;
| | - Cornelia D. Kazemali
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada; (C.M.-B.); (C.D.K.)
- Oncology Division, CHU de Québec-Université Laval Research Center, Quebec City, QC G1S 4L8, Canada;
| | - Julie Lapointe
- Oncology Division, CHU de Québec-Université Laval Research Center, Quebec City, QC G1S 4L8, Canada;
| | - Jacques Simard
- Endocrinology and Nephology Division, CHU de Québec-Université Laval Research Center, Quebec City, QC G1V 4G2, Canada;
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Hermann Nabi
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC G1V 0A6, Canada; (C.M.-B.); (C.D.K.)
- Oncology Division, CHU de Québec-Université Laval Research Center, Quebec City, QC G1S 4L8, Canada;
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Roberts E, van Veen EM, Byers H, Barnett-Griness O, Gronich N, Lejbkowicz F, Pinchev M, Smith MJ, Howell A, Newman WG, Woodward ER, Harkness EF, Brentnall AR, Cuzick J, Rennert G, Howell SJ, Evans DG. Breast cancer polygenic risk scores derived in White European populations are not calibrated for women of Ashkenazi Jewish descent. Genet Med 2023; 25:100846. [PMID: 37061873 DOI: 10.1016/j.gim.2023.100846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023] Open
Abstract
PURPOSE Polygenic risk scores (PRSs) are a major component of accurate breast cancer (BC) risk prediction but require ethnicity-specific calibration. Ashkenazi Jewish (AJ) population is assumed to be of White European (WE) origin in some commercially available PRSs despite differing effect allele frequencies (EAFs). We conducted a case-control study of WE and AJ women from the Predicting Risk of Cancer at Screening Study. The Breast Cancer in Northern Israel Study provided a separate AJ population-based case-control validation series. METHODS All women underwent Illumina OncoArray single-nucleotide variation (SNV; formerly single-nucleotide polymorphism [SNP]) analysis. Two PRSs were assessed, SNV142 and SNV78. A total of 221 of 2243 WE women (discovery: cases = 111; controls = 110; validation: cases = 651; controls = 1772) and 221 AJ women (cases = 121; controls = 110) were included from the UK study; the Israeli series consisted of 2045 AJ women (cases = 1331; controls = 714). EAFs were obtained from the Genome Aggregation Database. RESULTS In the UK study, the mean SNV142 PRS demonstrated good calibration and discrimination in WE population, with mean PRS of 1.33 (95% CI 1.18-1.48) in cases and 1.01 (95% CI 0.89-1.13) in controls. In AJ women from Manchester, the mean PRS of 1.54 (1.38-1.70) in cases and 1.20 (1.08-1.32) in controls demonstrated good discrimination but overestimation of BC relative risk. After adjusting for EAFs for the AJ population, mean risk was corrected (mean SNV142 PRS cases = 1.30 [95% CI 1.16-1.44] and controls = 1.02 [95% CI 0.92-1.12]). This was recapitulated in the larger Israeli data set with good discrimination (area under the curve = 0.632 [95% CI 0.607-0.657] for SNV142). CONCLUSION AJ women should not be given BC relative risk predictions based on PRSs calibrated to EAFs from the WE population. PRSs need to be recalibrated using AJ-derived EAFs. A simple recalibration using the mean PRS adjustment ratio likely performs well.
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Affiliation(s)
- Eleanor Roberts
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Elke M van Veen
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Helen Byers
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Ofra Barnett-Griness
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Naomi Gronich
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Flavio Lejbkowicz
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Mila Pinchev
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Miriam J Smith
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Anthony Howell
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Nightingale/Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Manchester Breast Centre, Manchester Cancer Research Centre, The Christie Hospital, Manchester, United Kingdom
| | - William G Newman
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Emma R Woodward
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Elaine F Harkness
- Nightingale/Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Adam R Brentnall
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Population Health, Charterhouse Square, London, United Kingdom
| | - Jack Cuzick
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Population Health, Charterhouse Square, London, United Kingdom
| | - Gad Rennert
- Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Sacha J Howell
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Nightingale/Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Manchester Breast Centre, Manchester Cancer Research Centre, The Christie Hospital, Manchester, United Kingdom
| | - D Gareth Evans
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; Nightingale/Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom; Manchester Breast Centre, Manchester Cancer Research Centre, The Christie Hospital, Manchester, United Kingdom.
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Akdeniz BC, Mattingsdal M, Dominguez-Valentin M, Frei O, Shadrin A, Puustusmaa M, Saar R, Sõber S, Møller P, Andreassen OA, Padrik P, Hovig E. A Breast Cancer Polygenic Risk Score Is Feasible for Risk Stratification in the Norwegian Population. Cancers (Basel) 2023; 15:4124. [PMID: 37627152 PMCID: PMC10452897 DOI: 10.3390/cancers15164124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Statistical associations of numerous single nucleotide polymorphisms with breast cancer (BC) have been identified in genome-wide association studies (GWAS). Recent evidence suggests that a Polygenic Risk Score (PRS) can be a useful risk stratification instrument for a BC screening strategy, and a PRS test has been developed for clinical use. The performance of the PRS is yet unknown in the Norwegian population. AIM To evaluate the performance of PRS models for BC in a Norwegian dataset. METHODS We investigated a sample of 1053 BC cases and 7094 controls from different regions of Norway. PRS values were calculated using four PRS models, and their performance was evaluated by the area under the curve (AUC) and the odds ratio (OR). The effect of the PRS on the age of onset of BC was determined by a Cox regression model, and the lifetime absolute risk of developing BC was calculated using the iCare tool. RESULTS The best performing PRS model included 3820 SNPs, which yielded an AUC = 0.625 and an OR = 1.567 per one standard deviation increase. The PRS values of the samples correlate with an increased risk of BC, with a hazard ratio of 1.494 per one standard deviation increase (95% confidence interval of 1.406-1.588). The individuals in the highest decile of the PRS have at least twice the risk of developing BC compared to the individuals with a median PRS. The results in this study with Norwegian samples are coherent with the findings in the study conducted using Estonian and UK Biobank samples. CONCLUSION The previously validated PRS models have a similar observed accuracy in the Norwegian data as in the UK and Estonian populations. A PRS provides a meaningful association with the age of onset of BC and lifetime risk. Therefore, as suggested in Estonia, a PRS may also be integrated into the screening strategy for BC in Norway.
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Affiliation(s)
- Bayram Cevdet Akdeniz
- Center for Bioinformatics, Department of Informatics, University of Oslo, 0313 Oslo, Norway (E.H.)
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, 4956 Oslo, Norway (O.A.A.)
| | - Morten Mattingsdal
- Center for Bioinformatics, Department of Informatics, University of Oslo, 0313 Oslo, Norway (E.H.)
- Department of Medical Research, Vestre Viken Hospital Trust, Bærum Hospital, 1346 Gjettum, Norway
| | - Mev Dominguez-Valentin
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, 0424 Oslo, Norway (P.M.)
| | - Oleksandr Frei
- Center for Bioinformatics, Department of Informatics, University of Oslo, 0313 Oslo, Norway (E.H.)
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, 4956 Oslo, Norway (O.A.A.)
| | - Alexey Shadrin
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, 4956 Oslo, Norway (O.A.A.)
| | | | - Regina Saar
- OÜ Antegenes, 50603 Tartu, Estonia; (M.P.); (R.S.)
| | - Siim Sõber
- OÜ Antegenes, 50603 Tartu, Estonia; (M.P.); (R.S.)
| | - Pål Møller
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, 0424 Oslo, Norway (P.M.)
| | - Ole A. Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, University of Oslo, 4956 Oslo, Norway (O.A.A.)
| | | | - Eivind Hovig
- Center for Bioinformatics, Department of Informatics, University of Oslo, 0313 Oslo, Norway (E.H.)
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital, 0424 Oslo, Norway (P.M.)
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7
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Nguyen AA, McCarthy AM, Kontos D. Combining Molecular and Radiomic Features for Risk Assessment in Breast Cancer. Annu Rev Biomed Data Sci 2023; 6:299-311. [PMID: 37159874 DOI: 10.1146/annurev-biodatasci-020722-092748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Breast cancer risk is highly variable within the population and current research is leading the shift toward personalized medicine. By accurately assessing an individual woman's risk, we can reduce the risk of over/undertreatment by preventing unnecessary procedures or by elevating screening procedures. Breast density measured from conventional mammography has been established as one of the most dominant risk factors for breast cancer; however, it is currently limited by its ability to characterize more complex breast parenchymal patterns that have been shown to provide additional information to strengthen cancer risk models. Molecular factors ranging from high penetrance, or high likelihood that a mutation will show signs and symptoms of the disease, to combinations of gene mutations with low penetrance have shown promise for augmenting risk assessment. Although imaging biomarkers and molecular biomarkers have both individually demonstrated improved performance in risk assessment, few studies have evaluated them together. This review aims to highlight the current state of the art in breast cancer risk assessment using imaging and genetic biomarkers.
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Affiliation(s)
- Alex A Nguyen
- Department of Bioengineering, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Despina Kontos
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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Damiani C, Kalliatakis G, Sreenivas M, Al-Attar M, Rose J, Pudney C, Lane EF, Cuzick J, Montana G, Brentnall AR. Evaluation of an AI Model to Assess Future Breast Cancer Risk. Radiology 2023; 307:e222679. [PMID: 37310244 DOI: 10.1148/radiol.222679] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background Accurate breast cancer risk assessment after a negative screening result could enable better strategies for early detection. Purpose To evaluate a deep learning algorithm for risk assessment based on digital mammograms. Materials and Methods A retrospective observational matched case-control study was designed using the OPTIMAM Mammography Image Database from the National Health Service Breast Screening Programme in the United Kingdom from February 2010 to September 2019. Patients with breast cancer (cases) were diagnosed following a mammographic screening or between two triannual screening rounds. Controls were matched based on mammography device, screening site, and age. The artificial intelligence (AI) model only used mammograms at screening before diagnosis. The primary objective was to assess model performance, with a secondary objective to assess heterogeneity and calibration slope. The area under the receiver operating characteristic curve (AUC) was estimated for 3-year risk. Heterogeneity according to cancer subtype was assessed using a likelihood ratio interaction test. Statistical significance was set at P < .05. Results Analysis included patients with screen-detected (median age, 60 years [IQR, 55-65 years]; 2044 female, including 1528 with invasive cancer and 503 with ductal carcinoma in situ [DCIS]) or interval (median age, 59 years [IQR, 53-65 years]; 696 female, including 636 with invasive cancer and 54 with DCIS) breast cancer and 1:1 matched controls, each with a complete set of mammograms at the screening preceding diagnosis. The AI model had an overall AUC of 0.68 (95% CI: 0.66, 0.70), with no evidence of a significant difference between interval and screen-detected (AUC, 0.69 vs 0.67; P = .085) cancer. The calibration slope was 1.13 (95% CI: 1.01, 1.26). There was similar performance for the detection of invasive cancer versus DCIS (AUC, 0.68 vs 0.66; P = .057). The model had higher performance for advanced cancer risk (AUC, 0.72 ≥stage II vs 0.66
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Affiliation(s)
- Celeste Damiani
- From the Center for Human Technologies, Istituto Italiano di Tecnologia, Via Melen 83, Genoa 16152, Italy (C.D.); Wolfson Institute of Population Health, Queen Mary University of London, London, UK (C.D., E.F.L., J.C., A.R.B.); Institute of Computer Science (ICS), Foundation of Research and Technology Hellas, Heraklion, Crete, Greece (G.K.); Joint for Director Breast Screening, University Hospitals Coventry and Warwickshire NHS Trust Coventry, Coventry, UK (M.S.); Department of Oncoplastic Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK (M.A.A.); Consumer member at National Cancer Research Institute, Breast Group, London, UK (J.R., C.P.); and University of Warwick, WMG, Coventry, UK (G.M.)
| | - Grigorios Kalliatakis
- From the Center for Human Technologies, Istituto Italiano di Tecnologia, Via Melen 83, Genoa 16152, Italy (C.D.); Wolfson Institute of Population Health, Queen Mary University of London, London, UK (C.D., E.F.L., J.C., A.R.B.); Institute of Computer Science (ICS), Foundation of Research and Technology Hellas, Heraklion, Crete, Greece (G.K.); Joint for Director Breast Screening, University Hospitals Coventry and Warwickshire NHS Trust Coventry, Coventry, UK (M.S.); Department of Oncoplastic Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK (M.A.A.); Consumer member at National Cancer Research Institute, Breast Group, London, UK (J.R., C.P.); and University of Warwick, WMG, Coventry, UK (G.M.)
| | - Muthyala Sreenivas
- From the Center for Human Technologies, Istituto Italiano di Tecnologia, Via Melen 83, Genoa 16152, Italy (C.D.); Wolfson Institute of Population Health, Queen Mary University of London, London, UK (C.D., E.F.L., J.C., A.R.B.); Institute of Computer Science (ICS), Foundation of Research and Technology Hellas, Heraklion, Crete, Greece (G.K.); Joint for Director Breast Screening, University Hospitals Coventry and Warwickshire NHS Trust Coventry, Coventry, UK (M.S.); Department of Oncoplastic Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK (M.A.A.); Consumer member at National Cancer Research Institute, Breast Group, London, UK (J.R., C.P.); and University of Warwick, WMG, Coventry, UK (G.M.)
| | - Miaad Al-Attar
- From the Center for Human Technologies, Istituto Italiano di Tecnologia, Via Melen 83, Genoa 16152, Italy (C.D.); Wolfson Institute of Population Health, Queen Mary University of London, London, UK (C.D., E.F.L., J.C., A.R.B.); Institute of Computer Science (ICS), Foundation of Research and Technology Hellas, Heraklion, Crete, Greece (G.K.); Joint for Director Breast Screening, University Hospitals Coventry and Warwickshire NHS Trust Coventry, Coventry, UK (M.S.); Department of Oncoplastic Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK (M.A.A.); Consumer member at National Cancer Research Institute, Breast Group, London, UK (J.R., C.P.); and University of Warwick, WMG, Coventry, UK (G.M.)
| | - Janice Rose
- From the Center for Human Technologies, Istituto Italiano di Tecnologia, Via Melen 83, Genoa 16152, Italy (C.D.); Wolfson Institute of Population Health, Queen Mary University of London, London, UK (C.D., E.F.L., J.C., A.R.B.); Institute of Computer Science (ICS), Foundation of Research and Technology Hellas, Heraklion, Crete, Greece (G.K.); Joint for Director Breast Screening, University Hospitals Coventry and Warwickshire NHS Trust Coventry, Coventry, UK (M.S.); Department of Oncoplastic Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK (M.A.A.); Consumer member at National Cancer Research Institute, Breast Group, London, UK (J.R., C.P.); and University of Warwick, WMG, Coventry, UK (G.M.)
| | - Clare Pudney
- From the Center for Human Technologies, Istituto Italiano di Tecnologia, Via Melen 83, Genoa 16152, Italy (C.D.); Wolfson Institute of Population Health, Queen Mary University of London, London, UK (C.D., E.F.L., J.C., A.R.B.); Institute of Computer Science (ICS), Foundation of Research and Technology Hellas, Heraklion, Crete, Greece (G.K.); Joint for Director Breast Screening, University Hospitals Coventry and Warwickshire NHS Trust Coventry, Coventry, UK (M.S.); Department of Oncoplastic Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK (M.A.A.); Consumer member at National Cancer Research Institute, Breast Group, London, UK (J.R., C.P.); and University of Warwick, WMG, Coventry, UK (G.M.)
| | - Emily F Lane
- From the Center for Human Technologies, Istituto Italiano di Tecnologia, Via Melen 83, Genoa 16152, Italy (C.D.); Wolfson Institute of Population Health, Queen Mary University of London, London, UK (C.D., E.F.L., J.C., A.R.B.); Institute of Computer Science (ICS), Foundation of Research and Technology Hellas, Heraklion, Crete, Greece (G.K.); Joint for Director Breast Screening, University Hospitals Coventry and Warwickshire NHS Trust Coventry, Coventry, UK (M.S.); Department of Oncoplastic Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK (M.A.A.); Consumer member at National Cancer Research Institute, Breast Group, London, UK (J.R., C.P.); and University of Warwick, WMG, Coventry, UK (G.M.)
| | - Jack Cuzick
- From the Center for Human Technologies, Istituto Italiano di Tecnologia, Via Melen 83, Genoa 16152, Italy (C.D.); Wolfson Institute of Population Health, Queen Mary University of London, London, UK (C.D., E.F.L., J.C., A.R.B.); Institute of Computer Science (ICS), Foundation of Research and Technology Hellas, Heraklion, Crete, Greece (G.K.); Joint for Director Breast Screening, University Hospitals Coventry and Warwickshire NHS Trust Coventry, Coventry, UK (M.S.); Department of Oncoplastic Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK (M.A.A.); Consumer member at National Cancer Research Institute, Breast Group, London, UK (J.R., C.P.); and University of Warwick, WMG, Coventry, UK (G.M.)
| | - Giovanni Montana
- From the Center for Human Technologies, Istituto Italiano di Tecnologia, Via Melen 83, Genoa 16152, Italy (C.D.); Wolfson Institute of Population Health, Queen Mary University of London, London, UK (C.D., E.F.L., J.C., A.R.B.); Institute of Computer Science (ICS), Foundation of Research and Technology Hellas, Heraklion, Crete, Greece (G.K.); Joint for Director Breast Screening, University Hospitals Coventry and Warwickshire NHS Trust Coventry, Coventry, UK (M.S.); Department of Oncoplastic Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK (M.A.A.); Consumer member at National Cancer Research Institute, Breast Group, London, UK (J.R., C.P.); and University of Warwick, WMG, Coventry, UK (G.M.)
| | - Adam R Brentnall
- From the Center for Human Technologies, Istituto Italiano di Tecnologia, Via Melen 83, Genoa 16152, Italy (C.D.); Wolfson Institute of Population Health, Queen Mary University of London, London, UK (C.D., E.F.L., J.C., A.R.B.); Institute of Computer Science (ICS), Foundation of Research and Technology Hellas, Heraklion, Crete, Greece (G.K.); Joint for Director Breast Screening, University Hospitals Coventry and Warwickshire NHS Trust Coventry, Coventry, UK (M.S.); Department of Oncoplastic Breast Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK (M.A.A.); Consumer member at National Cancer Research Institute, Breast Group, London, UK (J.R., C.P.); and University of Warwick, WMG, Coventry, UK (G.M.)
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9
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Harvie M, French DP, Pegington M, Lombardelli C, Krizak S, Sellers K, Barrett E, Gareth Evans D, Cutress R, Wilding RGN A, Graves L, Howell A. Randomised controlled trial of breast cancer and multiple disease prevention weight loss programmes vs written advice amongst women attending a breast cancer family history clinic. Br J Cancer 2023; 128:1690-1700. [PMID: 36841908 PMCID: PMC9961304 DOI: 10.1038/s41416-023-02207-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Overweight and obesity are common amongst women attending breast cancer Family History, Risk and Prevention Clinics (FHRPCs). Overweight increases risk of breast cancer (BC) and conditions including1 cardiovascular disease (CVD) and type-2 diabetes (T2D). Clinics provide written health behaviour advice with is likely to have minimal effects. We assessed efficacy of two remotely delivered weight loss programmes vs. written advice. METHOD 210 women with overweight or obesity attending three UK FHRPCs were randomised to either a BC prevention programme (BCPP) framed to reduce risk of BC (n = 86), a multiple disease prevention programme (MDPP) framed to reduce risk of BC, CVD and T2D (n = 87), or written advice (n = 37). Change in weight and health behaviours were assessed at 12-months. RESULTS Weight loss at 12 months was -6.3% (-8.2, -4.5) in BCPP, -6.0% (-7.9, -4.2) in MDPP and -3.3% (-6.2, -0.5) in the written group (p = 0.451 across groups). The percentage losing ≥10% weight in these groups were respectively 34%, 23% and 14% (p = 0.038 across groups). DISCUSSION BCPP and MDPP programmes resulted in more women achieving ≥10% weight loss, but no evidence of additional benefits of MDPP. A multicentre RCT to test the BCPP across UK FHRPCs is warranted. Clinical Trial Registration ISRCTN16431108.
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Affiliation(s)
- Michelle Harvie
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, England. .,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England. .,Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie, University of Manchester, 555 Wilmslow Rd, Manchester, M20 4GJ, England. .,Division of Cancer Sciences, The University of Manchester, Wilmslow Road, Manchester, M20 4BX, England.
| | - David P. French
- grid.498924.a0000 0004 0430 9101NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England ,grid.5379.80000000121662407Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie, University of Manchester, 555 Wilmslow Rd, Manchester, M20 4GJ England ,grid.5379.80000000121662407Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland Street, Manchester, M13 9PL England
| | - Mary Pegington
- grid.498924.a0000 0004 0430 9101The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT England ,grid.498924.a0000 0004 0430 9101NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England ,grid.5379.80000000121662407Division of Cancer Sciences, The University of Manchester, Wilmslow Road, Manchester, M20 4BX England
| | - Cheryl Lombardelli
- grid.498924.a0000 0004 0430 9101The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT England
| | - Suzy Krizak
- grid.498924.a0000 0004 0430 9101The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT England
| | - Katharine Sellers
- grid.498924.a0000 0004 0430 9101The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT England
| | - Emma Barrett
- grid.498924.a0000 0004 0430 9101Department of Medical Statistics, Education and Research Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT England
| | - D. Gareth Evans
- grid.498924.a0000 0004 0430 9101The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT England ,grid.498924.a0000 0004 0430 9101NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England ,grid.5379.80000000121662407Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie, University of Manchester, 555 Wilmslow Rd, Manchester, M20 4GJ England ,grid.5379.80000000121662407Genomic Medicine, Division of Evolution and Genomic Sciences, The University of Manchester, St Mary’s Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL England
| | - Ramsey Cutress
- grid.123047.30000000103590315University of Southampton and University Hospital Southampton NHS Foundation Trust, Somers Cancer Research Building, Southampton General Hospital, Mailpoint 824, Tremona Road, Southampton, SO16 6YD England
| | - Andrea Wilding RGN
- grid.498924.a0000 0004 0430 9101The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT England ,Tameside Macmillan Unit/Breast Service, Tameside and Glossop Integrated Care NHS Foundation Trust Fountain Street, Ashton-under-Lyne, OL6 9RW UK
| | - Lee Graves
- grid.4425.70000 0004 0368 0654School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, L3 5UX England
| | - Anthony Howell
- grid.498924.a0000 0004 0430 9101The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT England ,grid.498924.a0000 0004 0430 9101NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, England ,grid.5379.80000000121662407Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie, University of Manchester, 555 Wilmslow Rd, Manchester, M20 4GJ England ,grid.5379.80000000121662407Division of Cancer Sciences, The University of Manchester, Wilmslow Road, Manchester, M20 4BX England ,grid.412917.80000 0004 0430 9259Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX England
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10
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Roberts E, Howell S, Evans DG. Polygenic risk scores and breast cancer risk prediction. Breast 2023; 67:71-77. [PMID: 36646003 PMCID: PMC9982311 DOI: 10.1016/j.breast.2023.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023] Open
Abstract
Polygenic Risk Scores (PRS) are a major component of accurate breast cancer risk prediction and have the potential to improve screening and prevention strategies. PRS combine the risk from Single nucleotide polymorphisms (SNPs) associated with breast cancer in Genome Wide Association Studies (GWAS) and explain over 30% of breast cancer heritability. When incorporated into risk models, the more personalised risk assessment derived from PRS, help identify women at higher risk of breast cancer development and enables the implementation of stratified screening and prevention approaches. This review describes the role of PRS in breast cancer risk prediction including the development of PRS and their clinical application. We have also examined the role of PRS within more well-established risk prediction models which incorporate known classic risk factors and discuss the interaction of PRS with these factors and their capacity to predict breast cancer subtypes. Before PRS can be implemented on a population-wide scale, there are several challenges that must be addressed. Perhaps the most pressing of these is the use of PRS in women of non-White European origin, where PRS have been shown to have attenuated risk prediction both in discrimination and calibration. We discuss progress in developing and applying PRS in non-white European populations. PRS represent a significant advance in breast cancer risk prediction and their further development will undoubtedly enhance personalisation.
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Affiliation(s)
- Eleanor Roberts
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sacha Howell
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Nightingale/Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Manchester Breast Centre, Manchester Cancer Research Centre, The Christie Hospital, Manchester, UK
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Nightingale/Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Manchester Breast Centre, Manchester Cancer Research Centre, The Christie Hospital, Manchester, UK.
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11
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Mohammed TF, Qadir FA. Detection of IL-1β, VEGF and IL-4 with their novel genetic variations in breast cancer patients. Saudi J Biol Sci 2023; 30:103544. [PMID: 36619680 PMCID: PMC9812711 DOI: 10.1016/j.sjbs.2022.103544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/15/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Interleukin-1β (IL-1β), vascular endothelial growth factor (VEGF), and IL-4 serum levels and new genetic mutations in breast cancer (BC) patients were assessed in the current study. The serum levels of the examined cytokines in 40 BC patients and 40 control subjects were assessed using the ELISA technique. In order to identify genotype variants of the IL-1β, IL-4, and VEGF genes in 40 Formalin Fixed Paraffin Embedded (FFPE) samples with BC and 10 FFPE samples from healthy women's breast tissue, Sanger sequencing was used. According to this study, BC patients had significantly lower serum concentrations of IL-4 and significantly higher quantities of the tumor markers, CA15-3, IL-1β, and VEGF. In terms of genotype alterations, a total of 21 mutations in three trialed genes (eight in IL-1β, 10 in IL-4, and three in VEGF) were found in BC patients. The results of the current investigation suggested that angiogenesis and the development of BC may be significantly influenced by the genetic differences and higher levels of the examined cytokines.
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12
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Khorshid Shamshiri A, Alidoust M, Hemmati Nokandei M, Pasdar A, Afzaljavan F. Genetic architecture of mammographic density as a risk factor for breast cancer: a systematic review. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2023; 25:1729-1747. [PMID: 36639603 DOI: 10.1007/s12094-022-03071-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/30/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Mammography Density (MD) is a potential risk marker that is influenced by genetic polymorphisms and can subsequently modulate the risk of breast cancer. This qualitative systematic review summarizes the genes and biological pathways involved in breast density and discusses the potential clinical implications in view of the genetic risk profile for breast density. METHODS The terms related to "Common genetic variations" and "Breast density" were searched in Scopus, PubMed, and Web of Science databases. Gene pathways analysis and assessment of protein interactions were also performed. RESULTS Eighty-six studies including 111 genes, reported a significant association between mammographic density in different populations. ESR1, IGF1, IGFBP3, and ZNF365 were the most prevalent genes. Moreover, estrogen metabolism, signal transduction, and prolactin signaling pathways were significantly related to the associated genes. Mammography density was an associated phenotype, and eight out of 111 genes, including COMT, CYP19A1, CYP1B1, ESR1, IGF1, IGFBP1, IGFBP3, and LSP1, were modifiers of this trait. CONCLUSION Genes involved in developmental processes and the evolution of secondary sexual traits play an important role in determining mammographic density. Due to the effect of breast tissue density on the risk of breast cancer, these genes may also be associated with breast cancer risk.
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Affiliation(s)
- Asma Khorshid Shamshiri
- Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Alidoust
- Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahboubeh Hemmati Nokandei
- Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Pasdar
- Department of Medical Genetics and Molecular Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Division of Applied Medicine, Medical School, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Fahimeh Afzaljavan
- Clinical Research Development Unit, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, 917794-8564, Iran.
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13
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Jiao Y, Truong T, Eon-Marchais S, Mebirouk N, Caputo SM, Dondon MG, Karimi M, Le Gal D, Beauvallet J, Le Floch É, Dandine-Roulland C, Bacq-Daian D, Olaso R, Albuisson J, Audebert-Bellanger S, Berthet P, Bonadona V, Buecher B, Caron O, Cavaillé M, Chiesa J, Colas C, Collonge-Rame MA, Coupier I, Delnatte C, De Pauw A, Dreyfus H, Fert-Ferrer S, Gauthier-Villars M, Gesta P, Giraud S, Gladieff L, Golmard L, Lasset C, Lejeune-Dumoulin S, Léoné M, Limacher JM, Lortholary A, Luporsi É, Mari V, Maugard CM, Mortemousque I, Mouret-Fourme E, Nambot S, Noguès C, Popovici C, Prieur F, Pujol P, Sevenet N, Sobol H, Toulas C, Uhrhammer N, Vaur D, Venat L, Boland-Augé A, Guénel P, Deleuze JF, Stoppa-Lyonnet D, Andrieu N, Lesueur F. Association and performance of polygenic risk scores for breast cancer among French women presenting or not a familial predisposition to the disease. Eur J Cancer 2023; 179:76-86. [PMID: 36509001 DOI: 10.1016/j.ejca.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/26/2022] [Accepted: 11/06/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Three partially overlapping breast cancer polygenic risk scores (PRS) comprising 77, 179 and 313 SNPs have been proposed for European-ancestry women by the Breast Cancer Association Consortium (BCAC) for improving risk prediction in the general population. However, the effect of these SNPs may vary from one country to another and within a country because of other factors. OBJECTIVE To assess their associated risk and predictive performance in French women from (1) the CECILE population-based case-control study, (2) BRCA1 or BRCA2 (BRCA1/2) pathogenic variant (PV) carriers from the GEMO study, and (3) familial breast cancer cases with no BRCA1/2 PV and unrelated controls from the GENESIS study. RESULTS All three PRS were associated with breast cancer in all studies, with odds ratios per standard deviation varying from 1.7 to 2.0 in CECILE and GENESIS, and hazard ratios varying from 1.1 to 1.4 in GEMO. The predictive performance of PRS313 in CECILE was similar to that reported in BCAC but lower than that in GENESIS (area under the receiver operating characteristic curve (AUC) = 0.67 and 0.75, respectively). PRS were less performant in BRCA2 and BRCA1 PV carriers (AUC = 0.58 and 0.54 respectively). CONCLUSION Our results are in line with previous validation studies in the general population and in BRCA1/2 PV carriers. Additionally, we showed that PRS may be of clinical utility for women with a strong family history of breast cancer and no BRCA1/2 PV, and for those carrying a predicted PV in a moderate-risk gene like ATM, CHEK2 or PALB2.
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Affiliation(s)
- Yue Jiao
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Thérèse Truong
- Université Paris-Saclay, UVSQ, INSERM, U1018, Gustave Roussy, CESP, Team Exposome and Heredity, Villejuif, France
| | - Séverine Eon-Marchais
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Noura Mebirouk
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Sandrine M Caputo
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - Marie-Gabrielle Dondon
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Mojgan Karimi
- Université Paris-Saclay, UVSQ, INSERM, U1018, Gustave Roussy, CESP, Team Exposome and Heredity, Villejuif, France
| | - Dorothée Le Gal
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Juana Beauvallet
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Édith Le Floch
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Claire Dandine-Roulland
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Delphine Bacq-Daian
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Robert Olaso
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Juliette Albuisson
- Centre de Lutte contre le Cancer Georges François Leclerc, Dijon, France
| | | | - Pascaline Berthet
- Département de Biopathologie, Centre François Baclesse, Caen, France; INSERM, U1245, Rouen, France
| | - Valérie Bonadona
- Université Claude Bernard Lyon 1, Villeurbanne, France; CNRS UMR 5558, Centre Léon Bérard, Unité de Prévention et épidémiologie Génétique, Lyon, France
| | - Bruno Buecher
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - Olivier Caron
- Gustave Roussy, Département de Médecine Oncologique, Villejuif, France
| | - Mathias Cavaillé
- Université Clermont Auvergne, UMR INSERM, U1240, Clermont Ferrand, France; Département d'Oncogénétique, Centre Jean Perrin, Clermont Ferrand, France
| | - Jean Chiesa
- UF de Génétique Médicale et Cytogénétique, CHRU Caremeau, Nîmes, France
| | - Chrystelle Colas
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France; INSERM, U830, Paris, France
| | - Marie-Agnès Collonge-Rame
- Service Génétique et Biologie du Développement - Histologie, CHU Hôpital Saint-Jacques, Besançon, France
| | - Isabelle Coupier
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France; INSERM, U896, CRCM Val d'Aurelle, Montpellier, France
| | - Capucine Delnatte
- Institut de Cancérologie de l'Ouest, Unité d'Oncogénétique, Saint Herblain, France
| | - Antoine De Pauw
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - Hélène Dreyfus
- Clinique Sainte Catherine, Avignon, CHU de Grenoble, Grenoble, France; Hôpital Couple-Enfant, Département de Génétique, Grenoble, France
| | | | - Marion Gauthier-Villars
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - Paul Gesta
- CH Georges Renon, Service d'Oncogénétique Régional Poitou-Charentes, Niort, France
| | - Sophie Giraud
- Hospices Civils de Lyon, Service de Génétique, Groupement Hospitalier Est, Bron, France
| | - Laurence Gladieff
- Institut Claudius Regaud - IUCT-Oncopole, Service d'Oncologie Médicale, Toulouse, France
| | - Lisa Golmard
- PSL Research University, Paris, France; Department of Genetics, Institut Curie, Paris, France
| | - Christine Lasset
- Université Claude Bernard Lyon 1, Villeurbanne, France; CNRS UMR 5558, Centre Léon Bérard, Unité de Prévention et épidémiologie Génétique, Lyon, France
| | | | - Mélanie Léoné
- Hospices Civils de Lyon, Service de Génétique, Groupement Hospitalier Est, Bron, France
| | | | - Alain Lortholary
- Service d'Oncologie Médicale, Centre Catherine de Sienne, Nantes, France; Hôpital Privé du Confluent, Nantes, France
| | - Élisabeth Luporsi
- Service de Génétique UF4128 CHR Metz-Thionville, Hôpital de Mercy, Metz, France
| | - Véronique Mari
- Unité d'Oncogénétique, Centre Antoine Lacassagne, Nice, France
| | - Christine M Maugard
- Génétique Oncologique Moléculaire, UF1422, Département d'Oncobiologie, LBBM, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; UF6948 Génétique Oncologique Clinique, évaluation Familiale et Suivi, Strasbourg, France
| | | | | | - Sophie Nambot
- Centre de Lutte contre le Cancer Georges François Leclerc, Dijon, France; Institut GIMI, CHU de Dijon, Hôpital d'Enfants, France; Oncogénétique, Dijon, France
| | - Catherine Noguès
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli-Calmettes, Marseille, France; Aix Marseille Université, INSERM, IRD, SESSTIM, Marseille, France
| | - Cornel Popovici
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Fabienne Prieur
- CHU de Saint-Etienne; Hôpital Nord, Service de Génétique, Saint-Etienne, France
| | - Pascal Pujol
- Hôpital Arnaud de Villeneuve, CHU Montpellier, Service de Génétique Médicale et Oncogénétique, Montpellier, France; INSERM, U896, CRCM Val d'Aurelle, Montpellier, France
| | | | - Hagay Sobol
- Département d'Anticipation et de Suivi des Cancers, Oncogénétique Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Christine Toulas
- Institut Claudius Regaud - IUCT-Oncopole, Service d'Oncologie Médicale, Toulouse, France
| | - Nancy Uhrhammer
- Centre Jean Perrin, LBM OncoGenAuvergne, Clermont Ferrand, France
| | - Dominique Vaur
- Département de Biopathologie, Centre François Baclesse, Caen, France; INSERM, U1245, Rouen, France
| | - Laurence Venat
- Hôpital Universitaire Dupuytren, Service d'Oncologie Médicale, Limoges, France
| | - Anne Boland-Augé
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Pascal Guénel
- Université Paris-Saclay, UVSQ, INSERM, U1018, Gustave Roussy, CESP, Team Exposome and Heredity, Villejuif, France
| | - Jean-François Deleuze
- Centre National de Recherche en Génomique Humaine, Institut de Biologie François Jacob, CEA, Université Paris-Saclay, Evry, France
| | - Dominique Stoppa-Lyonnet
- Department of Genetics, Institut Curie, Paris, France; Département d'Oncogénétique, Centre Jean Perrin, Clermont Ferrand, France; Université Paris-Cité, Paris, France
| | - Nadine Andrieu
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France
| | - Fabienne Lesueur
- INSERM, U900, Paris, France; Institut Curie, Paris, France; Mines ParisTech, Fontainebleau, France; PSL Research University, Paris, France.
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14
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Wright SJ, Eden M, Ruane H, Byers H, Evans DG, Harvie M, Howell SJ, Howell A, French D, Payne K. Estimating the Cost of 3 Risk Prediction Strategies for Potential Use in the United Kingdom National Breast Screening Program. MDM Policy Pract 2023; 8:23814683231171363. [PMID: 37152662 PMCID: PMC10161319 DOI: 10.1177/23814683231171363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/29/2023] [Indexed: 05/09/2023] Open
Abstract
Background Economic evaluations have suggested that risk-stratified breast cancer screening may be cost-effective but have used assumptions to estimate the cost of risk prediction. The aim of this study was to identify and quantify the resource use and associated costs required to introduce a breast cancer risk-stratification approach into the English national breast screening program. Methods A micro-costing study, conducted alongside a cohort-based prospective trial (BC-PREDICT), identified the resource use and cost per individual (£; 2021 price year) of providing a risk-stratification strategy at a woman's first mammography. Costs were calculated for 3 risk-stratification approaches: Tyrer-Cuzick survey, Tyrer-Cuzick with Volpara breast-density measurement, and Tyrer-Cuzick with Volpara breast-density measurement and testing for 142 single nucleotide polymorphisms (SNP). Costs were determined for the intervention as implemented in the trial and in the health service. Results The cost of providing the risk-stratification strategy was calculated to be £16.45 for the Tyrer-Cuzick survey approach, £21.82 for the Tyrer-Cuzick with Volpara breast-density measurement, and £102.22 for the Tyrer-Cuzick with Volpara breast-density measurement and SNP testing. Limitations This study did not use formal expert elicitation methods to synthesize estimates. Conclusion The costs of risk prediction using a survey and breast density measurement were low, but adding SNP testing substantially increases costs. Implementation issues present in the trial may also significantly increase the cost of risk prediction. Implications This is the first study to robustly estimate the cost of risk-stratification for breast cancer screening. The cost of risk prediction using questionnaires and automated breast density measurement was low, but full economic evaluations including accurate costs are required to provide evidence of the cost-effectiveness of risk-stratified breast cancer screening. Highlights Economic evaluations have suggested that risk-stratified breast cancer screening may be a cost-effective use of resources in the United Kingdom.Current estimates of the cost of risk stratification are based on pragmatic assumptions.This study provides estimates of the cost of risk stratification using 3 strategies and when these strategies are implemented perfectly and imperfectly in the health system.The cost of risk stratification is relatively low unless single nucleotide polymorphisms are included in the strategy.
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Affiliation(s)
- Stuart J. Wright
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Martin Eden
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Helen Ruane
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Helen Byers
- Division of Evolution and Genomic Science, The University of Manchester, Manchester, UK
- Manchester Centre of Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - D. Gareth Evans
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Centre of Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Evolution and Genomic Science, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Health Innovation Manchester, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, The University of Manchester and Manchester University NHS foundation trust
| | - Michelle Harvie
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Health Innovation Manchester, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, The University of Manchester and Manchester University NHS foundation trust
| | - Sacha J. Howell
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, The University of Manchester and Manchester University NHS foundation trust
- The Christie NHS Foundation Trust, Manchester, UK
| | - Anthony Howell
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, The University of Manchester and Manchester University NHS foundation trust
- The Christie NHS Foundation Trust, Manchester, UK
| | - David French
- NIHR Manchester Biomedical Research Centre, The University of Manchester and Manchester University NHS foundation trust
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
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15
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Mavragani A, Davies A, Mueller J, Cholerton R, Howell A, Evans DG, Howell SJ, French DP, Harvie M. Evaluating the Acceptance and Usability of an App Promoting Weight Gain Prevention and Healthy Behaviors Among Young Women With a Family History of Breast Cancer: Protocol for an Observational Study. JMIR Res Protoc 2022; 11:e41246. [PMID: 36525287 PMCID: PMC9804094 DOI: 10.2196/41246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Breast cancer is the most common form of cancer in women, and around 20% of cases are associated with factors such as adult weight gain, overweight and obesity, and potentially modifiable health behaviors including high alcohol intake, smoking, lack of physical activity, and breastfeeding. Significant weight gain occurs between the ages of 18 and 35 years; hence, this age group could benefit from weight gain prevention interventions. Population studies have reported that women at increased risk of breast cancer account for a disproportionate amount of cases. Thus, there is a particular need to target weight gain prevention and other health behavior interventions for women at increased risk. A literature review identified no evidence-based apps that cover all relevant health behaviors. With patient and participant involvement from the target population, we have developed a new app to promote healthy behaviors among young women at increased risk of breast cancer. Alongside the app, a Facebook group provides peer support, and a virtual welcome event provides an overview of the project and the opportunity to meet the research team and other study participants. The aim of the intervention is to prevent weight gain via changes to eating habits and physical activity levels, and improve other health behaviors associated with breast cancer. The app includes goal setting and self-monitoring of health behaviors and provides education about breast cancer. OBJECTIVE This study aims to assess the acceptability and usability of the app in young women at increased risk of breast cancer, and the feasibility of the study procedures for a future, larger efficacy study. METHODS Young women (n=35, age 18-35 years) at increased risk of breast cancer (>17% lifetime risk) will be recruited via 2 recruitment procedures: mailed invite from the local breast cancer family history, risk and prevention clinic, and advertisements on social media and websites. Participants will have access to the app and the private Facebook group for 2 months. They will complete questionnaires regarding their health behaviors and breast cancer risk belief at the start and end of the study, complete app rating scales in the middle and at the end of the study, and be invited to give feedback on the app during the study period. Approximately 20 participants will have a semistructured interview at the end of the study regarding their views on the app and trial procedures. RESULTS The trial is ongoing, and the publication of results is anticipated in 2023. CONCLUSIONS The trial will provide evidence regarding the acceptability and usability of the newly developed app for young women at increased risk of breast cancer. Feedback obtained will be used to improve the app. The trial will also assess the feasibility of the study procedures and how these can be refined for a future efficacy study. TRIAL REGISTRATION ClinicalTrials.gov NCT05460650; https://clinicaltrials.gov/ct2/show/NCT05460650. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/41246.
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Affiliation(s)
| | - Alan Davies
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, United Kingdom
| | - Julia Mueller
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Rachel Cholerton
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Anthony Howell
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom.,The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Manchester Breast Centre, University of Manchester, Manchester, United Kingdom.,Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - D Gareth Evans
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Manchester Breast Centre, University of Manchester, Manchester, United Kingdom.,Division of Evolution, Infection and Genomics, University of Manchester, Manchester, United Kingdom
| | - Sacha J Howell
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom.,The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Manchester Breast Centre, University of Manchester, Manchester, United Kingdom.,Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, United Kingdom.,Manchester Breast Centre, University of Manchester, Manchester, United Kingdom
| | - Michelle Harvie
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom.,The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Manchester Breast Centre, University of Manchester, Manchester, United Kingdom
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16
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Evans DGR, van Veen EM, Harkness EF, Brentnall AR, Astley SM, Byers H, Woodward ER, Sampson S, Southworth J, Howell SJ, Maxwell AJ, Newman WG, Cuzick J, Howell A. Breast cancer risk stratification in women of screening age: Incremental effects of adding mammographic density, polygenic risk, and a gene panel. Genet Med 2022; 24:1485-1494. [PMID: 35426792 DOI: 10.1016/j.gim.2022.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/17/2022] Open
Abstract
PURPOSE There is great promise in breast cancer risk stratification to target screening and prevention. It is unclear whether adding gene panels to other risk tools improves breast cancer risk stratification and adds discriminatory benefit on a population basis. METHODS In total, 10,025 of 57,902 women aged 46 to 73 years in the Predicting Risk of Cancer at Screening study provided DNA samples. A case-control study was used to evaluate breast cancer risk assessment using polygenic risk scores (PRSs), cancer gene panel (n = 33), mammographic density (density residual [DR]), and risk factors collected using a self-completed 2-page questionnaire (Tyrer-Cuzick [TC] model version 8). In total, 525 cases and 1410 controls underwent gene panel testing and PRS calculation (18, 143, and/or 313 single-nucleotide polymorphisms [SNPs]). RESULTS Actionable pathogenic variants (PGVs) in BRCA1/2 were found in 1.7% of cases and 0.55% of controls, and overall PGVs were found in 6.1% of cases and 1.3% of controls. A combined assessment of TC8-DR-SNP313 and gene panel provided the best risk stratification with 26.1% of controls and 9.7% of cases identified at <1.4% 10-year risk and 9.01% of controls and 23.3% of cases at ≥8% 10-year risk. Because actionable PGVs were uncommon, discrimination was identical with/without gene panel (with/without: area under the curve = 0.67, 95% CI = 0.64-0.70). Only 7 of 17 PGVs in cases resulted in actionable risk category change. Extended case (n = 644)-control (n = 1779) series with TC8-DR-SNP143 identified 18.9% of controls and only 6.4% of stage 2+ cases at <1.4% 10-year risk and 20.7% of controls and 47.9% of stage 2+ cases at ≥5% 10-year risk. CONCLUSION Further studies and economic analysis will determine whether adding panels to PRS is a cost-effective strategy for risk stratification.
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Affiliation(s)
- D Gareth R Evans
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Prevention Breast Cancer Unit and Nightingale Breast Screening Centre, Manchester University NHS Foundation Trust (South), Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust (Central), Manchester, United Kingdom; Manchester Breast Centre, Manchester Cancer Research Centre, The University of Manchester, Manchester, United Kingdom; Cancer Prevention Early Detection Theme, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - Elke M van Veen
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Elaine F Harkness
- Prevention Breast Cancer Unit and Nightingale Breast Screening Centre, Manchester University NHS Foundation Trust (South), Manchester, United Kingdom; Cancer Prevention Early Detection Theme, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Adam R Brentnall
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Charterhouse Square, Barts and The London, Queen Mary University of London, London, United Kingdom
| | - Susan M Astley
- Prevention Breast Cancer Unit and Nightingale Breast Screening Centre, Manchester University NHS Foundation Trust (South), Manchester, United Kingdom; Manchester Breast Centre, Manchester Cancer Research Centre, The University of Manchester, Manchester, United Kingdom; Cancer Prevention Early Detection Theme, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - Helen Byers
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Cancer Prevention Early Detection Theme, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Emma R Woodward
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Cancer Prevention Early Detection Theme, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sarah Sampson
- Prevention Breast Cancer Unit and Nightingale Breast Screening Centre, Manchester University NHS Foundation Trust (South), Manchester, United Kingdom
| | - Jake Southworth
- Prevention Breast Cancer Unit and Nightingale Breast Screening Centre, Manchester University NHS Foundation Trust (South), Manchester, United Kingdom
| | - Sacha J Howell
- Prevention Breast Cancer Unit and Nightingale Breast Screening Centre, Manchester University NHS Foundation Trust (South), Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Manchester Breast Centre, Manchester Cancer Research Centre, The University of Manchester, Manchester, United Kingdom; Cancer Prevention Early Detection Theme, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Anthony J Maxwell
- Prevention Breast Cancer Unit and Nightingale Breast Screening Centre, Manchester University NHS Foundation Trust (South), Manchester, United Kingdom; Manchester Breast Centre, Manchester Cancer Research Centre, The University of Manchester, Manchester, United Kingdom; Cancer Prevention Early Detection Theme, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom
| | - William G Newman
- Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom; Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust (Central), Manchester, United Kingdom; Manchester Breast Centre, Manchester Cancer Research Centre, The University of Manchester, Manchester, United Kingdom
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Charterhouse Square, Barts and The London, Queen Mary University of London, London, United Kingdom
| | - Anthony Howell
- Prevention Breast Cancer Unit and Nightingale Breast Screening Centre, Manchester University NHS Foundation Trust (South), Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Manchester Breast Centre, Manchester Cancer Research Centre, The University of Manchester, Manchester, United Kingdom; Cancer Prevention Early Detection Theme, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
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17
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Hou C, Xu B, Hao Y, Yang D, Song H, Li J. Development and validation of polygenic risk scores for prediction of breast cancer and breast cancer subtypes in Chinese women. BMC Cancer 2022; 22:374. [PMID: 35395775 PMCID: PMC8991589 DOI: 10.1186/s12885-022-09425-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/15/2022] [Indexed: 02/08/2023] Open
Abstract
Background Studies investigating breast cancer polygenic risk score (PRS) in Chinese women are scarce. The objectives of this study were to develop and validate PRSs that could be used to stratify risk for overall and subtype-specific breast cancer in Chinese women, and to evaluate the performance of a newly proposed Artificial Neural Network (ANN) based approach for PRS construction. Methods The PRSs were constructed using the dataset from a genome-wide association study (GWAS) and validated in an independent case-control study. Three approaches, including repeated logistic regression (RLR), logistic ridge regression (LRR) and ANN based approach, were used to build the PRSs for overall and subtype-specific breast cancer based on 24 selected single nucleotide polymorphisms (SNPs). Predictive performance and calibration of the PRSs were evaluated unadjusted and adjusted for Gail-2 model 5-year risk or classical breast cancer risk factors. Results The primary PRSANN and PRSLRR both showed modest predictive ability for overall breast cancer (odds ratio per interquartile range increase of the PRS in controls [IQ-OR] 1.76 vs 1.58; area under the receiver operator characteristic curve [AUC] 0.601 vs 0.598) and remained to be predictive after adjustment. Although estrogen receptor negative (ER−) breast cancer was poorly predicted by the primary PRSs, the ER− PRSs trained solely on ER− breast cancer cases saw a substantial improvement in predictions of ER− breast cancer. Conclusions The 24 SNPs based PRSs can provide additional risk information to help breast cancer risk stratification in the general population of China. The newly proposed ANN approach for PRS construction has potential to replace the traditional approaches, but more studies are needed to validate and investigate its performance. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09425-3.
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Affiliation(s)
- Can Hou
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610047, Sichuan, China.,Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 Ren Min Nan Lu, Chengdu, 610041, Sichuan, China.,Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Bin Xu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 Ren Min Nan Lu, Chengdu, 610041, Sichuan, China
| | - Yu Hao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 Ren Min Nan Lu, Chengdu, 610041, Sichuan, China
| | - Daowen Yang
- Robot Perception and Control Joint Lab, Sichuan University & Aisono, Chengdu, China
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610047, Sichuan, China. .,Med-X Center for Informatics, Sichuan University, Chengdu, China.
| | - Jiayuan Li
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 Ren Min Nan Lu, Chengdu, 610041, Sichuan, China.
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18
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Evans DG, van Veen EM, Byers H, Roberts E, Howell A, Howell SJ, Harkness EF, Brentnall A, Cuzick J, Newman WG. The importance of ethnicity: Are breast cancer polygenic risk scores ready for women who are not of White European origin? Int J Cancer 2022; 150:73-79. [PMID: 34460111 PMCID: PMC9290473 DOI: 10.1002/ijc.33782] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/08/2021] [Accepted: 08/02/2021] [Indexed: 11/07/2022]
Abstract
Polygenic risk scores (PRS) for disease risk stratification show great promise for application in general populations, but most are based on data from individuals of White European origin. We assessed two well validated PRS (SNP18, SNP143) in the Predicting-Risk-of-Cancer-At-Screening (PROCAS) study in North-West England for breast cancer prediction based on ethnicity. Overall, 9475 women without breast cancer at study entry, including 645 who subsequently developed invasive breast cancer or ductal carcinoma in situ provided DNA. All were genotyped for SNP18 and a subset of 1868 controls were genotyped for SNP143. For White Europeans both PRS discriminated well between individuals with and without cancer. For n = 395 Black (n = 112), Asian (n = 119), mixed (n = 44) or Jewish (n = 120) women without cancer both PRS overestimated breast cancer risk, being most marked for women of Black and Jewish origin (P < .001). SNP143 resulted in a potential mean 40% breast cancer risk overestimation in the combined group of non-White/non-European origin. SNP-PRS that has been normalized based on White European ethnicity for breast cancer should not be used to predict risk in women of other ethnicities. There is an urgent need to develop PRS specific for other ethnicities, in order to widen access of this technology.
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MESH Headings
- Adult
- Aged
- Biomarkers, Tumor/genetics
- Breast Density
- Breast Neoplasms/epidemiology
- Breast Neoplasms/genetics
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/genetics
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Case-Control Studies
- England/epidemiology
- Ethnicity/genetics
- Female
- Follow-Up Studies
- Genetic Predisposition to Disease
- Humans
- Middle Aged
- Polymorphism, Single Nucleotide
- Prognosis
- Risk Factors
- White People/genetics
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Affiliation(s)
- D. Gareth Evans
- Nightingale/Prevent Breast Cancer Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
- Manchester Breast Centre, Manchester Cancer Research CentreThe Christie HospitalManchesterUK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester Academic Health Science CentreManchesterUK
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
| | - Elke M. van Veen
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
| | - Helen Byers
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
| | - Eleanor Roberts
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester Academic Health Science CentreManchesterUK
| | - Anthony Howell
- Nightingale/Prevent Breast Cancer Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
- Manchester Breast Centre, Manchester Cancer Research CentreThe Christie HospitalManchesterUK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester Academic Health Science CentreManchesterUK
| | - Sacha J. Howell
- Nightingale/Prevent Breast Cancer Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
- Manchester Breast Centre, Manchester Cancer Research CentreThe Christie HospitalManchesterUK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of ManchesterManchester Academic Health Science CentreManchesterUK
| | - Elaine F. Harkness
- Nightingale/Prevent Breast Cancer Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Adam Brentnall
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive MedicineLondonUK
| | - Jack Cuzick
- Queen Mary University of London, Centre for Cancer Prevention, Wolfson Institute of Preventive MedicineLondonUK
| | - William G. Newman
- Clinical Genetics Service, Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation TrustManchesterUK
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreManchesterUK
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19
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Wang Y, Zhu M, Ma H, Shen H. Polygenic risk scores: the future of cancer risk prediction, screening, and precision prevention. MEDICAL REVIEW (BERLIN, GERMANY) 2021; 1:129-149. [PMID: 37724297 PMCID: PMC10471106 DOI: 10.1515/mr-2021-0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/13/2021] [Indexed: 09/20/2023]
Abstract
Genome-wide association studies (GWASs) have shown that the genetic architecture of cancers are highly polygenic and enabled researchers to identify genetic risk loci for cancers. The genetic variants associated with a cancer can be combined into a polygenic risk score (PRS), which captures part of an individual's genetic susceptibility to cancer. Recently, PRSs have been widely used in cancer risk prediction and are shown to be capable of identifying groups of individuals who could benefit from the knowledge of their probabilistic susceptibility to cancer, which leads to an increased interest in understanding the potential utility of PRSs that might further refine the assessment and management of cancer risk. In this context, we provide an overview of the major discoveries from cancer GWASs. We then review the methodologies used for PRS construction, and describe steps for the development and evaluation of risk prediction models that include PRS and/or conventional risk factors. Potential utility of PRSs in cancer risk prediction, screening, and precision prevention are illustrated. Challenges and practical considerations relevant to the implementation of PRSs in health care settings are discussed.
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Affiliation(s)
- Yuzhuo Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
- Department of Medical Informatics, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Meng Zhu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hongxia Ma
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Research Units of Cohort Study on Cardiovascular Diseases and Cancers, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongbing Shen
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu, China
- Research Units of Cohort Study on Cardiovascular Diseases and Cancers, Chinese Academy of Medical Sciences, Beijing, China
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20
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Lelièvre SA. Can the epigenome contribute to risk stratification for cancer onset? NAR Cancer 2021; 3:zcab043. [PMID: 34734185 PMCID: PMC8559165 DOI: 10.1093/narcan/zcab043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/10/2021] [Accepted: 10/27/2021] [Indexed: 12/12/2022] Open
Abstract
The increasing burden of cancer requires identifying and protecting individuals at highest risk. The epigenome provides an indispensable complement to genetic alterations for a risk stratification approach for the following reasons: gene transcription necessary for cancer onset is directed by epigenetic modifications and many risk factors studied so far have been associated with alterations related to the epigenome. The risk level depends on the plasticity of the epigenome during phases of life particularly sensitive to environmental and dietary impacts. Modifications in the activity of DNA regulatory regions and altered chromatin compaction may accumulate, hence leading to the increase of cancer risk. Moreover, tissue architecture directs the unique organization of the epigenome for each tissue and cell type, which allows the epigenome to control cancer risk in specific organs. Investigations of epigenetic signatures of risk should help identify a continuum of alterations leading to a threshold beyond which the epigenome cannot maintain homeostasis. We propose that this threshold may be similar in the population for a given tissue, but the pace to reach this threshold will depend on the combination of germline inheritance and the risk and protective factors encountered, particularly during windows of epigenetic susceptibility, by individuals.
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Affiliation(s)
- Sophie A Lelièvre
- Institut de Cancérologie de l'Ouest (ICO)-Western Cancer Institute, Scientific Direction for Translational Research, Angers, France
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21
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Huilgol YS, Keane H, Shieh Y, Hiatt RA, Tice JA, Madlensky L, Sabacan L, Fiscalini AS, Ziv E, Acerbi I, Che M, Anton-Culver H, Borowsky AD, Hunt S, Naeim A, Parker BA, van 't Veer LJ, Esserman LJ. Elevated risk thresholds predict endocrine risk-reducing medication use in the Athena screening registry. NPJ Breast Cancer 2021; 7:102. [PMID: 34344894 PMCID: PMC8333106 DOI: 10.1038/s41523-021-00306-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/24/2021] [Indexed: 11/09/2022] Open
Abstract
Risk-reducing endocrine therapy use, though the benefit is validated, is extremely low. The FDA has approved tamoxifen and raloxifene for a 5-year Breast Cancer Risk Assessment Tool (BCRAT) risk ≥ 1.67%. We examined the threshold at which high-risk women are likely to be using endocrine risk-reducing therapies among Athena Breast Health Network participants from 2011-2018. We identified high-risk women by a 5-year BCRAT risk ≥ 1.67% and those in the top 10% and 2.5% risk thresholds by age. We estimated the odds ratio (OR) of current medication use based on these thresholds using logistic regression. One thousand two hundred and one (1.2%) of 104,223 total participants used medication. Of the 33,082 participants with 5-year BCRAT risk ≥ 1.67%, 772 (2.3%) used medication. Of 2445 in the top 2.5% threshold, 209 (8.6%) used medication. Participants whose 5-year risk exceeded 1.67% were more likely to use medication than those whose risk was below this threshold, OR 3.94 (95% CI = 3.50-4.43). The top 2.5% was most strongly associated with medication usage, OR 9.50 (8.13-11.09) compared to the bottom 97.5%. Women exceeding a 5-year BCRAT ≥ 1.67% had modest medication use. We demonstrate that women in the top 2.5% have higher odds of medication use than those in the bottom 97.5% and compared to a risk of 1.67%. The top 2.5% threshold would more effectively target medication use and is being tested prospectively in a randomized control clinical trial.
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Affiliation(s)
- Yash S Huilgol
- University of California, San Francisco, San Francisco, CA, USA
- University of California, Berkeley, Berkeley, CA, USA
| | - Holly Keane
- University of California, San Francisco, San Francisco, CA, USA
- Peter MacCallum Cancer Centre, Melbourne, Melbourne, VIC, Australia
| | - Yiwey Shieh
- University of California, San Francisco, San Francisco, CA, USA
| | - Robert A Hiatt
- University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey A Tice
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Leah Sabacan
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Elad Ziv
- University of California, San Francisco, San Francisco, CA, USA
| | - Irene Acerbi
- University of California, San Francisco, San Francisco, CA, USA
| | - Mandy Che
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | - Arash Naeim
- University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Laura J Esserman
- University of California, San Francisco, San Francisco, CA, USA.
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22
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Kurian AW, Hughes E, Simmons T, Bernhisel R, Probst B, Meek S, Caswell-Jin JL, John EM, Lanchbury JS, Slavin TP, Wagner S, Gutin A, Rohan TE, Shadyab AH, Manson JE, Lane D, Chlebowski RT, Stefanick ML. Performance of the IBIS/Tyrer-Cuzick model of breast cancer risk by race and ethnicity in the Women's Health Initiative. Cancer 2021; 127:3742-3750. [PMID: 34228814 DOI: 10.1002/cncr.33767] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/28/2021] [Accepted: 06/05/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The IBIS/Tyrer-Cuzick model is used clinically to guide breast cancer screening and prevention, but was developed primarily in non-Hispanic White women. Little is known about its long-term performance in a racially/ethnically diverse population. METHODS The Women's Health Initiative study enrolled postmenopausal women from 1993-1998. Women were included who were aged <80 years at enrollment with no prior breast cancer or mastectomy and with data required for IBIS/Tyrer-Cuzick calculation (weight; height; ages at menarche, first birth, and menopause; menopausal hormone therapy use; and family history of breast or ovarian cancer). Calibration was assessed by the ratio of observed breast cancer cases to the number expected by the IBIS/Tyrer-Cuzick model (O/E; calculated as the sum of cumulative hazards). Differential discrimination was tested for by self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, Asian or Pacific Islander, and American Indian or Alaskan Native) using Cox regression. Exploratory analyses, including simulation of a protective single-nucleotide polymorphism (SNP), rs140068132 at 6q25, were performed. RESULTS During follow-up (median 18.9 years, maximum 23.4 years), 6783 breast cancer cases occurred among 90,967 women. IBIS/Tyrer-Cuzick was well calibrated overall (O/E ratio = 0.95; 95% CI, 0.93-0.97) and in most racial/ethnic groups, but overestimated risk for Hispanic women (O/E ratio = 0.75; 95% CI, 0.62-0.90). Discrimination did not differ by race/ethnicity. Exploratory simulation of the protective SNP suggested improved IBIS/Tyrer-Cuzick calibration for Hispanic women (O/E ratio = 0.80; 95% CI, 0.66-0.96). CONCLUSIONS The IBIS/Tyrer-Cuzick model is well calibrated for several racial/ethnic groups over 2 decades of follow-up. Studies that incorporate genetic and other risk factors, particularly among Hispanic women, are essential to improve breast cancer-risk prediction.
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Affiliation(s)
- Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, Stanford, California.,Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | | | | - Esther M John
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, California
| | | | | | | | | | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dorothy Lane
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Rowan T Chlebowski
- Department of Medicine, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Marcia L Stefanick
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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23
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Li SX, Milne RL, Nguyen-Dumont T, Wang X, English DR, Giles GG, Southey MC, Antoniou AC, Lee A, Li S, Winship I, Hopper JL, Terry MB, MacInnis RJ. Prospective Evaluation of the Addition of Polygenic Risk Scores to Breast Cancer Risk Models. JNCI Cancer Spectr 2021; 5:pkab021. [PMID: 33977228 PMCID: PMC8099999 DOI: 10.1093/jncics/pkab021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/13/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background The Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm and the International Breast Cancer Intervention Study breast cancer risk models are used to provide advice on screening intervals and chemoprevention. We evaluated the performance of these models, which now incorporate polygenic risk scores (PRSs), using a prospective cohort study. Methods We used a case-cohort design, involving women in the Melbourne Collaborative Cohort Study aged 50-75 years when surveyed in 2003-2007, of whom 408 had a first primary breast cancer diagnosed within 10 years (cases), and 2783 were from the subcohort. Ten-year risks were calculated based on lifestyle factors, family history data, and a 313-variant PRS. Discrimination was assessed using a C-statistic compared with 0.50 and calibration using the ratio of expected to observed number of cases (E/O). Results When the PRS was added to models with lifestyle factors and family history, the C-statistic (95% confidence interval [CI]) increased from 0.57 (0.54 to 0.60) to 0.62 (0.60 to 0.65) using IBIS and from 0.56 (0.53 to 0.59) to 0.62 (0.59 to 0.64) using BOADICEA. IBIS underpredicted risk (E/O = 0.62, 95% CI = 0.48 to 0.80) for women in the lowest risk category (<1.7%) and overpredicted risk (E/O = 1.40, 95% CI = 1.18 to 1.67) in the highest risk category (≥5%), using the Hosmer-Lemeshow test for calibration in quantiles of risk and a 2-sided P value less than .001. BOADICEA underpredicted risk (E/O = 0.82, 95% CI = 0.67 to 0.99) in the second highest risk category (3.4%-5%); the Hosmer-Lemeshow test and a 2-sided P value was equal to .02. Conclusions Although the inclusion of a 313 genetic variant PRS doubles discriminatory accuracy (relative to reference 0.50), models with and without this PRS have relatively modest discrimination and might require recalibration before their clinical and wider use are promoted.
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Affiliation(s)
- Sherly X Li
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Tu Nguyen-Dumont
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Clinical Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Xiaochuan Wang
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Dallas R English
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Graham G Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Melissa C Southey
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Clinical Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Antonis C Antoniou
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, UK
| | - Andrew Lee
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, UK
| | - Shuai Li
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, UK
| | - Ingrid Winship
- Department of Genomic Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Robert J MacInnis
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
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24
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Woodward ER, van Veen EM, Evans DG. From BRCA1 to Polygenic Risk Scores: Mutation-Associated Risks in Breast Cancer-Related Genes. Breast Care (Basel) 2021; 16:202-213. [PMID: 34248461 DOI: 10.1159/000515319] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Background There has been huge progress over the last 30 years in identifying the familial component of breast cancer. Summary Currently around 20% is explained by the high-risk genes BRCA1 and BRCA2, a further 2% by other high-penetrance genes, and around 5% by the moderate risk genes ATM and CHEK2. In contrast, the more than 300 low-penetrance single-nucleotide polymorphisms (SNP) now account for around 28% and they are predicted to account for most of the remaining 45% yet to be found. Even for high-risk genes which confer a 40-90% risk of breast cancer, these SNP can substantially affect the level of breast cancer risk. Indeed, the strength of family history and hormonal and reproductive factors is very important in assessing risk even for a BRCA carrier. The risks of contralateral breast cancer are also affected by SNP as well as by the presence of high or moderate risk genes. Genetic testing using gene panels is now commonplace. Key-Messages There is a need for a more parsimonious approach to panels only testing those genes with a definite 2-fold increased risk and only testing those genes with challenging management implications, such as CDH1 and TP53, when there is strong clinical indication to do so. Testing of SNP alongside genes is likely to provide a more accurate risk assessment.
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Affiliation(s)
- Emma R Woodward
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.,Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Elke M van Veen
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.,Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom.,Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,PREVENT Breast Cancer Prevention Centre, Nightingale Centre, Manchester Universities Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom.,Manchester Breast Centre, Manchester Cancer Research Centre, The Christie, University of Manchester, Manchester, United Kingdom
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25
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Kim G, Bahl M. Assessing Risk of Breast Cancer: A Review of Risk Prediction Models. JOURNAL OF BREAST IMAGING 2021; 3:144-155. [PMID: 33778488 DOI: 10.1093/jbi/wbab001] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Indexed: 12/17/2022]
Abstract
Accurate and individualized breast cancer risk assessment can be used to guide personalized screening and prevention recommendations. Existing risk prediction models use genetic and nongenetic risk factors to provide an estimate of a woman's breast cancer risk and/or the likelihood that she has a BRCA1 or BRCA2 mutation. Each model is best suited for specific clinical scenarios and may have limited applicability in certain types of patients. For example, the Breast Cancer Risk Assessment Tool, which identifies women who would benefit from chemoprevention, is readily accessible and user-friendly but cannot be used in women under 35 years of age or those with prior breast cancer or lobular carcinoma in situ. Emerging research on deep learning-based artificial intelligence (AI) models suggests that mammographic images contain risk indicators that could be used to strengthen existing risk prediction models. This article reviews breast cancer risk factors, describes the appropriate use, strengths, and limitations of each risk prediction model, and discusses the emerging role of AI for risk assessment.
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Affiliation(s)
- Geunwon Kim
- Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA, USA
| | - Manisha Bahl
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
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26
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Pal Choudhury P, Brook MN, Hurson AN, Lee A, Mulder CV, Coulson P, Schoemaker MJ, Jones ME, Swerdlow AJ, Chatterjee N, Antoniou AC, Garcia-Closas M. Comparative validation of the BOADICEA and Tyrer-Cuzick breast cancer risk models incorporating classical risk factors and polygenic risk in a population-based prospective cohort of women of European ancestry. Breast Cancer Res 2021; 23:22. [PMID: 33588869 PMCID: PMC7885342 DOI: 10.1186/s13058-021-01399-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/25/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) and the Tyrer-Cuzick breast cancer risk prediction models are commonly used in clinical practice and have recently been extended to include polygenic risk scores (PRS). In addition, BOADICEA has also been extended to include reproductive and lifestyle factors, which were already part of Tyrer-Cuzick model. We conducted a comparative prospective validation of these models after incorporating the recently developed 313-variant PRS. METHODS Calibration and discrimination of 5-year absolute risk was assessed in a nested case-control sample of 1337 women of European ancestry (619 incident breast cancer cases) aged 23-75 years from the Generations Study. RESULTS The extended BOADICEA model with reproductive/lifestyle factors and PRS was well calibrated across risk deciles; expected-to-observed ratio (E/O) at the highest risk decile :0.97 (95 % CI 0.51 - 1.86) for women younger than 50 years and 1.09 (0.66 - 1.80) for women 50 years or older. Adding reproductive/lifestyle factors and PRS to the BOADICEA model improved discrimination modestly in younger women (area under the curve (AUC) 69.7 % vs. 69.1%) and substantially in older women (AUC 64.6 % vs. 56.8%). The Tyrer-Cuzick model with PRS showed evidence of overestimation at the highest risk decile: E/O = 1.54(0.81 - 2.92) for younger and 1.73 (1.03 - 2.90) for older women. CONCLUSION The extended BOADICEA model identified women in a European-ancestry population at elevated breast cancer risk more accurately than the Tyrer-Cuzick model with PRS. With the increasing availability of PRS, these analyses can inform choice of risk models incorporating PRS for risk stratified breast cancer prevention among women of European ancestry.
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Affiliation(s)
- Parichoy Pal Choudhury
- Division of Cancer Epidemiology and Genetics, National Cancer Institute of Health, 9609 Medical Center Drive 7E-342, Rockville, MD, 20850, USA
| | - Mark N Brook
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Amber N Hurson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute of Health, 9609 Medical Center Drive 7E-342, Rockville, MD, 20850, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew Lee
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Charlotta V Mulder
- Division of Cancer Epidemiology and Genetics, National Cancer Institute of Health, 9609 Medical Center Drive 7E-342, Rockville, MD, 20850, USA
| | - Penny Coulson
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Michael E Jones
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
- Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | - Nilanjan Chatterjee
- Department of Biostatistics, The Johns Hopkins University, MD, Baltimore, USA
| | - Antonis C Antoniou
- Department of Public Health and Primary Care, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute of Health, 9609 Medical Center Drive 7E-342, Rockville, MD, 20850, USA.
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27
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Hughes E, Tshiaba P, Wagner S, Judkins T, Rosenthal E, Roa B, Gallagher S, Meek S, Dalton K, Hedegard W, Adami CA, Grear DF, Domchek SM, Garber J, Lancaster JM, Weitzel JN, Kurian AW, Lanchbury JS, Gutin A, Robson ME. Integrating Clinical and Polygenic Factors to Predict Breast Cancer Risk in Women Undergoing Genetic Testing. JCO Precis Oncol 2021; 5:PO.20.00246. [PMID: 34036224 PMCID: PMC8140787 DOI: 10.1200/po.20.00246] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/30/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Screening and prevention decisions for women at increased risk of developing breast cancer depend on genetic and clinical factors to estimate risk and select appropriate interventions. Integration of polygenic risk into clinical breast cancer risk estimators can improve discrimination. However, correlated genetic effects must be incorporated carefully to avoid overestimation of risk. MATERIALS AND METHODS A novel Fixed-Stratified method was developed that accounts for confounding when adding a new factor to an established risk model. A combined risk score (CRS) of an 86-single-nucleotide polymorphism polygenic risk score and the Tyrer-Cuzick v7.02 clinical risk estimator was generated with attenuation for confounding by family history. Calibration and discriminatory accuracy of the CRS were evaluated in two independent validation cohorts of women of European ancestry (N = 1,615 and N = 518). Discrimination for remaining lifetime risk was examined by age-adjusted logistic regression. Risk stratification with a 20% risk threshold was compared between CRS and Tyrer-Cuzick in an independent clinical cohort (N = 32,576). RESULTS Simulation studies confirmed that the Fixed-Stratified method produced accurate risk estimation across patients with different family history. In both validation studies, CRS and Tyrer-Cuzick were significantly associated with breast cancer. In an analysis with both CRS and Tyrer-Cuzick as predictors of breast cancer, CRS added significant discrimination independent of that captured by Tyrer-Cuzick (P < 10-11 in validation 1; P < 10-7 in validation 2). In an independent cohort, 18% of women shifted breast cancer risk categories from their Tyrer-Cuzick-based risk compared with risk estimates by CRS. CONCLUSION Integrating clinical and polygenic factors into a risk model offers more effective risk stratification and supports a personalized genomic approach to breast cancer screening and prevention.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Danna F. Grear
- The Breast Center of NWA-Medical Associates of Northwest Arkansas, Fayetteville, AR
| | - Susan M. Domchek
- Basser Center for BRCA, University of Pennsylvania, Philadelphia, PA
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Long-Term Evaluation of Women Referred to a Breast Cancer Family History Clinic (Manchester UK 1987-2020). Cancers (Basel) 2020; 12:cancers12123697. [PMID: 33317064 PMCID: PMC7763143 DOI: 10.3390/cancers12123697] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary This study reports the management of women at high risk for breast cancer over a 33 years period. The aim was to summarize the numbers seen and to report the results of our studies on gene testing, the outcomes of screening and the success of preventive methods including lifestyle change, chemoprevention and risk-reducing mastectomy. We also discuss how the clinical Family History Service may be improved in the future. Abstract Clinics for women concerned about their family history of breast cancer are widely established. A Family History Clinic was set-up in Manchester, UK, in 1987 in a Breast Unit serving a population of 1.8 million. In this review, we report the outcome of risk assessment, screening and prevention strategies in the clinic and propose future approaches. Between 1987–2020, 14,311 women were referred, of whom 6.4% were from known gene families, 38.2% were at high risk (≥30% lifetime risk), 37.7% at moderate risk (17–29%), and 17.7% at an average/population risk who were discharged. A total of 4168 (29.1%) women were eligible for genetic testing and 736 carried pathogenic variants, predominantly in BRCA1 and BRCA2 but also other genes (5.1% of direct referrals). All women at high or moderate risk were offered annual mammographic screening between ages 30 and 40 years old: 646 cancers were detected in women at high and moderate risk (5.5%) with a detection rate of 5 per 1000 screens. Incident breast cancers were largely of good prognosis and resulted in a predicted survival advantage. All high/moderate-risk women were offered lifestyle prevention advice and 14–27% entered various lifestyle studies. From 1992–2003, women were offered entry into IBIS-I (tamoxifen) and IBIS-II (anastrozole) trials (12.5% of invitees joined). The NICE guidelines ratified the use of tamoxifen and raloxifene (2013) and subsequently anastrozole (2017) for prevention; 10.8% women took up the offer of such treatment between 2013–2020. Since 1994, 7164 eligible women at ≥25% lifetime risk of breast cancer were offered a discussion of risk-reducing breast surgery and 451 (6.2%) had surgery. New approaches in all aspects of the service are needed to build on these results.
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Rosner B, Tamimi RM, Kraft P, Gao C, Mu Y, Scott C, Winham SJ, Vachon CM, Colditz GA. Simplified Breast Risk Tool Integrating Questionnaire Risk Factors, Mammographic Density, and Polygenic Risk Score: Development and Validation. Cancer Epidemiol Biomarkers Prev 2020; 30:600-607. [PMID: 33277321 DOI: 10.1158/1055-9965.epi-20-0900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/01/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Clinical use of breast cancer risk prediction requires simplified models. We evaluate a simplified version of the validated Rosner-Colditz model and add percent mammographic density (MD) and polygenic risk score (PRS), to assess performance from ages 45-74. We validate using the Mayo Mammography Health Study (MMHS). METHODS We derived the model in the Nurses' Health Study (NHS) based on: MD, 77 SNP PRS and a questionnaire score (QS; lifestyle and reproductive factors). A total of 2,799 invasive breast cancer cases were diagnosed from 1990-2000. MD (using Cumulus software) and PRS were assessed in a nested case-control study. We assess model performance using this case-control dataset and evaluate 10-year absolute breast cancer risk. The prospective MMHS validation dataset includes 21.8% of women age <50, and 434 incident cases identified over 10 years of follow-up. RESULTS In the NHS, MD has the highest odds ratio (OR) for 10-year risk prediction: ORper SD = 1.48 [95% confidence interval (CI): 1.31-1.68], followed by PRS, ORper SD = 1.37 (95% CI: 1.21-1.55) and QS, ORper SD = 1.25 (95% CI: 1.11-1.41). In MMHS, the AUC adjusted for age + MD + QS 0.650; for age + MD + QS + PRS 0.687, and the NRI was 6% in cases and 16% in controls. CONCLUSION A simplified assessment of QS, MD, and PRS performs consistently to discriminate those at high 10-year breast cancer risk. IMPACT This simplified model provides accurate estimation of 10-year risk of invasive breast cancer that can be used in a clinical setting to identify women who may benefit from chemopreventive intervention.See related commentary by Tehranifar et al., p. 587.
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Affiliation(s)
- Bernard Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Epidemiology, Population Health Sciences Department, Weill Cornell Medicine, New York, New York
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Peter Kraft
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Chi Gao
- Program in Genetic Epidemiology and Statistical Genetics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yi Mu
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Christopher Scott
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Stacey J Winham
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Celine M Vachon
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Graham A Colditz
- Alvin J. Siteman Cancer Center and Department of Surgery, Division of Public Health Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
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30
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Kramer I, Hooning MJ, Mavaddat N, Hauptmann M, Keeman R, Steyerberg EW, Giardiello D, Antoniou AC, Pharoah PDP, Canisius S, Abu-Ful Z, Andrulis IL, Anton-Culver H, Aronson KJ, Augustinsson A, Becher H, Beckmann MW, Behrens S, Benitez J, Bermisheva M, Bogdanova NV, Bojesen SE, Bolla MK, Bonanni B, Brauch H, Bremer M, Brucker SY, Burwinkel B, Castelao JE, Chan TL, Chang-Claude J, Chanock SJ, Chenevix-Trench G, Choi JY, Clarke CL, Collée JM, Couch FJ, Cox A, Cross SS, Czene K, Daly MB, Devilee P, Dörk T, Dos-Santos-Silva I, Dunning AM, Dwek M, Eccles DM, Evans DG, Fasching PA, Flyger H, Gago-Dominguez M, García-Closas M, García-Sáenz JA, Giles GG, Goldgar DE, González-Neira A, Haiman CA, Håkansson N, Hamann U, Hartman M, Heemskerk-Gerritsen BAM, Hollestelle A, Hopper JL, Hou MF, Howell A, Ito H, Jakimovska M, Jakubowska A, Janni W, John EM, Jung A, Kang D, Kets CM, Khusnutdinova E, Ko YD, Kristensen VN, Kurian AW, Kwong A, Lambrechts D, Le Marchand L, Li J, Lindblom A, Lubiński J, Mannermaa A, Manoochehri M, Margolin S, Matsuo K, Mavroudis D, Meindl A, Milne RL, Mulligan AM, Muranen TA, Neuhausen SL, Nevanlinna H, Newman WG, Olshan AF, Olson JE, Olsson H, Park-Simon TW, Peto J, Petridis C, Plaseska-Karanfilska D, Presneau N, Pylkäs K, Radice P, Rennert G, Romero A, Roylance R, Saloustros E, Sawyer EJ, Schmutzler RK, Schwentner L, Scott C, See MH, Shah M, Shen CY, Shu XO, Siesling S, Slager S, Sohn C, Southey MC, Spinelli JJ, Stone J, Tapper WJ, Tengström M, Teo SH, Terry MB, Tollenaar RAEM, Tomlinson I, Troester MA, Vachon CM, van Ongeval C, van Veen EM, Winqvist R, Wolk A, Zheng W, Ziogas A, Easton DF, Hall P, Schmidt MK. Breast Cancer Polygenic Risk Score and Contralateral Breast Cancer Risk. Am J Hum Genet 2020; 107:837-848. [PMID: 33022221 PMCID: PMC7675034 DOI: 10.1016/j.ajhg.2020.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022] Open
Abstract
Previous research has shown that polygenic risk scores (PRSs) can be used to stratify women according to their risk of developing primary invasive breast cancer. This study aimed to evaluate the association between a recently validated PRS of 313 germline variants (PRS313) and contralateral breast cancer (CBC) risk. We included 56,068 women of European ancestry diagnosed with first invasive breast cancer from 1990 onward with follow-up from the Breast Cancer Association Consortium. Metachronous CBC risk (N = 1,027) according to the distribution of PRS313 was quantified using Cox regression analyses. We assessed PRS313 interaction with age at first diagnosis, family history, morphology, ER status, PR status, and HER2 status, and (neo)adjuvant therapy. In studies of Asian women, with limited follow-up, CBC risk associated with PRS313 was assessed using logistic regression for 340 women with CBC compared with 12,133 women with unilateral breast cancer. Higher PRS313 was associated with increased CBC risk: hazard ratio per standard deviation (SD) = 1.25 (95%CI = 1.18-1.33) for Europeans, and an OR per SD = 1.15 (95%CI = 1.02-1.29) for Asians. The absolute lifetime risks of CBC, accounting for death as competing risk, were 12.4% for European women at the 10th percentile and 20.5% at the 90th percentile of PRS313. We found no evidence of confounding by or interaction with individual characteristics, characteristics of the primary tumor, or treatment. The C-index for the PRS313 alone was 0.563 (95%CI = 0.547-0.586). In conclusion, PRS313 is an independent factor associated with CBC risk and can be incorporated into CBC risk prediction models to help improve stratification and optimize surveillance and treatment strategies.
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Affiliation(s)
- Iris Kramer
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Molecular Pathology, Amsterdam 1066 CX, the Netherlands
| | - Maartje J Hooning
- Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam 3015 CN, the Netherlands
| | - Nasim Mavaddat
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Cambridge CB1 8RN, UK
| | - Michael Hauptmann
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Epidemiology and Biostatistics, Amsterdam 1066 CX, the Netherlands; Brandenburg Medical School Theodor Fontane, Institute of Biostatistics and Registry Research, Neuruppin 16816, Germany
| | - Renske Keeman
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Molecular Pathology, Amsterdam 1066 CX, the Netherlands
| | - Ewout W Steyerberg
- Leiden University Medical Center, Department of Biomedical Data Sciences, Leiden 2333 ZA, the Netherlands; Erasmus MC, Department of Public Health, Rotterdam 3015 GD, the Netherlands
| | - Daniele Giardiello
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Molecular Pathology, Amsterdam 1066 CX, the Netherlands; Leiden University Medical Center, Department of Biomedical Data Sciences, Leiden 2333 ZA, the Netherlands
| | - Antonis C Antoniou
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Cambridge CB1 8RN, UK
| | - Paul D P Pharoah
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Cambridge CB1 8RN, UK; University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge CB1 8RN, UK
| | - Sander Canisius
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Molecular Pathology, Amsterdam 1066 CX, the Netherlands; The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Molecular Carcinogenesis, Amsterdam 1066 CX, the Netherlands
| | - Zumuruda Abu-Ful
- Carmel Medical Center and Technion Faculty of Medicine, Clalit National Cancer Control Center, Haifa 35254, Israel
| | - Irene L Andrulis
- Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital, Fred A. Litwin Center for Cancer Genetics, Toronto, ON M5G 1X5, Canada; University of Toronto, Department of Molecular Genetics, Toronto, ON M5S 1A8, Canada
| | - Hoda Anton-Culver
- University of California Irvine, Department of Epidemiology, Genetic Epidemiology Research Institute, Irvine, CA 92617, USA
| | - Kristan J Aronson
- Queen's University, Department of Public Health Sciences, and Cancer Research Institute, Kingston, ON K7L 3N6, Canada
| | - Annelie Augustinsson
- Lund University, Department of Cancer Epidemiology, Clinical Sciences, Lund 222 42, Sweden
| | - Heiko Becher
- University Medical Center Hamburg-Eppendorf, Institute of Medical Biometry and Epidemiology, Hamburg 20246, Germany; Charité -Universitätsmedizin Berlin, Institute of Biometry and Clinical Epidemiology, Berlin 10117, Germany
| | - Matthias W Beckmann
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen 91054, Germany
| | - Sabine Behrens
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg 69120, Germany
| | - Javier Benitez
- Centro de Investigación en Red de Enfermedades Raras (CIBERER), Madrid 28029, Spain; Spanish National Cancer Research Centre (CNIO), Human Cancer Genetics Programme, Madrid 28029, Spain
| | - Marina Bermisheva
- Ufa Federal Research Centre of the Russian Academy of Sciences, Institute of Biochemistry and Genetics, Ufa 450054, Russia
| | - Natalia V Bogdanova
- Hannover Medical School, Department of Radiation Oncology, Hannover 30625, Germany; Hannover Medical School, Gynaecology Research Unit, Hannover 30625, Germany; N.N. Alexandrov Research Institute of Oncology and Medical Radiology, Minsk 223040, Belarus
| | - Stig E Bojesen
- Copenhagen University Hospital, Copenhagen General Population Study, Herlev and Gentofte Hospital, Herlev 2730, Denmark; Copenhagen University Hospital, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Herlev 2730, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen 2200, Denmark
| | - Manjeet K Bolla
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Cambridge CB1 8RN, UK
| | - Bernardo Bonanni
- IEO, European Institute of Oncology IRCCS, Division of Cancer Prevention and Genetics, Milan 20141, Italy
| | - Hiltrud Brauch
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart 70376, Germany; University of Tübingen, iFIT-Cluster of Excellence, Tübingen 72074, Germany; German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Partner Site Tübingen, Tübingen 72074, Germany
| | - Michael Bremer
- Hannover Medical School, Department of Radiation Oncology, Hannover 30625, Germany
| | - Sara Y Brucker
- University of Tübingen, Department of Gynecology and Obstetrics, Tübingen 72076, Germany
| | - Barbara Burwinkel
- German Cancer Research Center (DKFZ), Molecular Epidemiology Group, C080, Heidelberg 69120, Germany; University of Heidelberg, Molecular Biology of Breast Cancer, University Womens Clinic Heidelberg, Heidelberg 69120, Germany
| | - Jose E Castelao
- Instituto de Investigacion Sanitaria Galicia Sur (IISGS), Xerencia de Xestion Integrada de Vigo-SERGAS, Oncology and Genetics Unit, Vigo 36312, Spain
| | - Tsun L Chan
- Hong Kong Hereditary Breast Cancer Family Registry, Hong Kong; Hong Kong Sanatorium and Hospital, Department of Pathology, Happy Valley, Hong Kong
| | - Jenny Chang-Claude
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg 69120, Germany; University Medical Center Hamburg-Eppendorf, Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), Hamburg 20246, Germany
| | - Stephen J Chanock
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, Bethesda, MD 20850, USA
| | - Georgia Chenevix-Trench
- QIMR Berghofer Medical Research Institute, Department of Genetics and Computational Biology, Brisbane, QLD 4006, Australia
| | - Ji-Yeob Choi
- Seoul National University Graduate School, Department of Biomedical Sciences, Seoul 03080, Korea; Seoul National University, Cancer Research Institute, Seoul 03080, Korea
| | - Christine L Clarke
- University of Sydney, Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
| | - J Margriet Collée
- Erasmus University Medical Center, Department of Clinical Genetics, Rotterdam 3015 CN, the Netherlands
| | - Fergus J Couch
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN 55905, USA
| | - Angela Cox
- University of Sheffield, Sheffield Institute for Nucleic Acids (SInFoNiA), Department of Oncology and Metabolism, Sheffield S10 2TN, UK
| | - Simon S Cross
- University of Sheffield, Academic Unit of Pathology, Department of Neuroscience, Sheffield S10 2TN, UK
| | - Kamila Czene
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm 171 65, Sweden
| | - Mary B Daly
- Fox Chase Cancer Center, Department of Clinical Genetics, Philadelphia, PA 19111, USA
| | - Peter Devilee
- Leiden University Medical Center, Department of Pathology, Leiden 2333 ZA, the Netherlands; Leiden University Medical Center, Department of Human Genetics, Leiden 2333 ZA, the Netherlands
| | - Thilo Dörk
- Hannover Medical School, Gynaecology Research Unit, Hannover 30625, Germany
| | - Isabel Dos-Santos-Silva
- London School of Hygiene and Tropical Medicine, Department of Non-Communicable Disease Epidemiology, London WC1E 7HT, UK
| | - Alison M Dunning
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge CB1 8RN, UK
| | - Miriam Dwek
- University of Westminster, School of Life Sciences, London W1B 2HW, UK
| | - Diana M Eccles
- University of Southampton, Faculty of Medicine, Southampton SO17 1BJ, UK
| | - D Gareth Evans
- University of Manchester, Manchester Academic Health Science Centre, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester M13 9WL, UK; St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, North West Genomics Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester M13 9WL, UK
| | - Peter A Fasching
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Department of Gynecology and Obstetrics, Comprehensive Cancer Center ER-EMN, Erlangen 91054, Germany; University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine Division of Hematology and Oncology, Los Angeles, CA 90095, USA
| | - Henrik Flyger
- Copenhagen University Hospital, Department of Breast Surgery, Herlev and Gentofte Hospital, Herlev 2730, Denmark
| | - Manuela Gago-Dominguez
- Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela 15706, Spain; University of California San Diego, Moores Cancer Center, La Jolla, CA 92037, USA
| | - Montserrat García-Closas
- National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, Bethesda, MD 20850, USA
| | - José A García-Sáenz
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Centro Investigación Biomédica en Red de Cáncer (CIBERONC), Medical Oncology Department, Hospital Clínico San Carlos, Madrid 28040, Spain
| | - Graham G Giles
- Cancer Council Victoria, Cancer Epidemiology Division, Melbourne, VIC 3004, Australia; The University of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, VIC 3010, Australia; Monash University, Precision Medicine, School of Clinical Sciences at Monash Health, Clayton, VIC 3168, Australia
| | - David E Goldgar
- Huntsman Cancer Institute, University of Utah School of Medicine, Department of Dermatology, Salt Lake City, UT 84112, USA
| | - Anna González-Neira
- Spanish National Cancer Research Centre (CNIO), Human Cancer Genetics Programme, Madrid 28029, Spain
| | - Christopher A Haiman
- University of Southern California, Department of Preventive Medicine, Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Niclas Håkansson
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm 171 77, Sweden
| | - Ute Hamann
- German Cancer Research Center (DKFZ), Molecular Genetics of Breast Cancer, Heidelberg 69120, Germany
| | - Mikael Hartman
- National University of Singapore and National University Health System, Saw Swee Hock School of Public Health, Singapore 119077, Singapore; National University Health System, Department of Surgery, Singapore 119228, Singapore
| | | | - Antoinette Hollestelle
- Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam 3015 CN, the Netherlands
| | - John L Hopper
- The University of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, VIC 3010, Australia
| | - Ming-Feng Hou
- Kaohsiung Medical University, Chung-Ho Memorial Hospital, Kaohsiung 807, Taiwan
| | - Anthony Howell
- University of Manchester, Division of Cancer Sciences, Manchester M13 9PL, UK
| | - Hidemi Ito
- Aichi Cancer Center Research Institute, Division of Cancer Epidemiology and Prevention, Nagoya 464-8681, Japan; Nagoya University Graduate School of Medicine, Division of Cancer Epidemiology, Nagoya 466-8550, Japan
| | - Milena Jakimovska
- MASA, Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov', Skopje 1000, Republic of North Macedonia
| | - Anna Jakubowska
- Pomeranian Medical University, Department of Genetics and Pathology, Szczecin 71-252, Poland; Pomeranian Medical University, Independent Laboratory of Molecular Biology and Genetic Diagnostics, Szczecin 71-252, Poland
| | - Wolfgang Janni
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm 89075, Germany
| | - Esther M John
- Stanford Cancer Institute, Stanford University School of Medicine, Department of Epidemiology & Population Health, Stanford, CA 94304, USA
| | - Audrey Jung
- German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg 69120, Germany
| | - Daehee Kang
- Seoul National University Graduate School, Department of Biomedical Sciences, Seoul 03080, Korea; Seoul National University, Cancer Research Institute, Seoul 03080, Korea; Seoul National University College of Medicine, Department of Preventive Medicine, Seoul 03080, Korea
| | - C Marleen Kets
- the Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Department of Clinical Genetics, Amsterdam 1066 CX, the Netherlands
| | - Elza Khusnutdinova
- Ufa Federal Research Centre of the Russian Academy of Sciences, Institute of Biochemistry and Genetics, Ufa 450054, Russia; Bashkir State University, Department of Genetics and Fundamental Medicine, Ufa 450000, Russia
| | - Yon-Dschun Ko
- Johanniter Krankenhaus, Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Bonn 53177, Germany
| | - Vessela N Kristensen
- Oslo University Hospital-Radiumhospitalet, Department of Cancer Genetics, Institute for Cancer Research, Oslo 0379, Norway; Oslo University Hospital and University of Olso, Department of Medical Genetics, Oslo 0379, Norway
| | - Allison W Kurian
- Stanford Cancer Institute, Stanford University School of Medicine, Department of Epidemiology & Population Health, Stanford, CA 94304, USA; Stanford University School of Medicine, Department of Health Research and Policy, Stanford, CA 94305, USA
| | - Ava Kwong
- Hong Kong Hereditary Breast Cancer Family Registry, Hong Kong; The University of Hong Kong, Department of Surgery, Pok Fu Lam, Hong Kong; Hong Kong Sanatorium and Hospital, Cancer Genetics Center and Department of Surgery, Happy Valley, Hong Kong
| | - Diether Lambrechts
- VIB Center for Cancer Biology, Leuven 3001, Belgium; University of Leuven, Laboratory for Translational Genetics, Department of Human Genetics, Leuven 3000, Belgium
| | - Loic Le Marchand
- University of Hawaii Cancer Center, Epidemiology Program, Honolulu, HI 96813, USA
| | - Jingmei Li
- Genome Institute of Singapore, Human Genetics Division, Singapore 138672, Singapore
| | - Annika Lindblom
- Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm 171 76, Sweden; Karolinska University Hospital, Department of Clinical Genetics, Stockholm 171 76, Sweden
| | - Jan Lubiński
- Pomeranian Medical University, Department of Genetics and Pathology, Szczecin 71-252, Poland
| | - Arto Mannermaa
- University of Eastern Finland, Translational Cancer Research Area, Kuopio 70210, Finland; University of Eastern Finland, Institute of Clinical Medicine, Pathology and Forensic Medicine, Kuopio 70210, Finland; Kuopio University Hospital, Biobank of Eastern Finland, Kuopio 70210, Finland
| | - Mehdi Manoochehri
- German Cancer Research Center (DKFZ), Molecular Genetics of Breast Cancer, Heidelberg 69120, Germany
| | - Sara Margolin
- Södersjukhuset, Department of Oncology, Stockholm 118 83, Sweden; Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm 118 83, Sweden
| | - Keitaro Matsuo
- Aichi Cancer Center Research Institute, Division of Cancer Epidemiology and Prevention, Nagoya 464-8681, Japan; Nagoya University Graduate School of Medicine, Division of Cancer Epidemiology, Nagoya 466-8550, Japan
| | - Dimitrios Mavroudis
- University Hospital of Heraklion, Department of Medical Oncology, Heraklion 711 10, Greece
| | - Alfons Meindl
- University of Munich, Campus Großhadern, Department of Gynecology and Obstetrics, Munich 81377, Germany
| | - Roger L Milne
- Cancer Council Victoria, Cancer Epidemiology Division, Melbourne, VIC 3004, Australia; The University of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, VIC 3010, Australia; Monash University, Precision Medicine, School of Clinical Sciences at Monash Health, Clayton, VIC 3168, Australia
| | - Anna Marie Mulligan
- University of Toronto, Department of Laboratory Medicine and Pathobiology, Toronto, ON M5S 1A8, Canada; University Health Network, Laboratory Medicine Program, Toronto, ON M5G 2C4, Canada
| | - Taru A Muranen
- Helsinki University Hospital, Department of Obstetrics and Gynecology, University of Helsinki, Helsinki 00290, Finland
| | - Susan L Neuhausen
- Beckman Research Institute of City of Hope, Department of Population Sciences, Duarte, CA 91010, USA
| | - Heli Nevanlinna
- Helsinki University Hospital, Department of Obstetrics and Gynecology, University of Helsinki, Helsinki 00290, Finland
| | - William G Newman
- University of Manchester, Manchester Academic Health Science Centre, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester M13 9WL, UK; St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, North West Genomics Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester M13 9WL, UK
| | - Andrew F Olshan
- University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA
| | - Janet E Olson
- Mayo Clinic, Department of Health Sciences Research, Rochester, MN 55905, USA
| | - Håkan Olsson
- Lund University, Department of Cancer Epidemiology, Clinical Sciences, Lund 222 42, Sweden
| | | | - Julian Peto
- London School of Hygiene and Tropical Medicine, Department of Non-Communicable Disease Epidemiology, London WC1E 7HT, UK
| | - Christos Petridis
- King's College London, Research Oncology, Guy's Hospital, London SE1 9RT, UK
| | - Dijana Plaseska-Karanfilska
- MASA, Research Centre for Genetic Engineering and Biotechnology 'Georgi D. Efremov', Skopje 1000, Republic of North Macedonia
| | - Nadege Presneau
- University of Westminster, School of Life Sciences, London W1B 2HW, UK
| | - Katri Pylkäs
- University of Oulu, Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit, Biocenter Oulu, Oulu 90220, Finland; Northern Finland Laboratory Centre Oulu, Laboratory of Cancer Genetics and Tumor Biology, Oulu 90220, Finland
| | - Paolo Radice
- Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Unit of Molecular Bases of Genetic Risk and Genetic Testing, Department of Research, Milan 20133, Italy
| | - Gad Rennert
- Carmel Medical Center and Technion Faculty of Medicine, Clalit National Cancer Control Center, Haifa 35254, Israel
| | - Atocha Romero
- Hospital Universitario Puerta de Hierro, Medical Oncology Department, Madrid 28222, Spain
| | - Rebecca Roylance
- UCLH Foundation Trust, Department of Oncology, London NW1 2PG, UK
| | | | - Elinor J Sawyer
- King's College London, School of Cancer & Pharmaceutical Sciences, Comprehensive Cancer Centre, Guy's Campus, London SE1 1UL, UK
| | - Rita K Schmutzler
- Faculty of Medicine and University Hospital Cologne, University of Cologne, Center for Familial Breast and Ovarian Cancer, Cologne 50937, Germany; Faculty of Medicine and University Hospital Cologne, University of Cologne, Center for Integrated Oncology (CIO), Cologne 50937, Germany; Faculty of Medicine and University Hospital Cologne, University of Cologne, Center for Molecular Medicine Cologne (CMMC), Cologne 50931, Germany
| | - Lukas Schwentner
- University Hospital Ulm, Department of Gynaecology and Obstetrics, Ulm 89075, Germany
| | - Christopher Scott
- Mayo Clinic, Department of Health Sciences Research, Rochester, MN 55905, USA
| | - Mee-Hoong See
- University of Malaya, Breast Cancer Research Unit, University Malaya Cancer Research Institute, Faculty of Medicine, Kuala Lumpur 50603, Malaysia
| | - Mitul Shah
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge CB1 8RN, UK
| | - Chen-Yang Shen
- Academia Sinica, Institute of Biomedical Sciences, Taipei 115, Taiwan; China Medical University, School of Public Health, Taichung 40402, Taiwan
| | - Xiao-Ou Shu
- Vanderbilt University School of Medicine, Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research, Utrecht 3511 DT, the Netherlands; University of Twente, Department of Health Technology and Service Research, Technical Medical Center, Enschede 7522 NB, the Netherlands
| | - Susan Slager
- Mayo Clinic, Department of Health Sciences Research, Rochester, MN 55905, USA
| | - Christof Sohn
- University Hospital and German Cancer Research Center, National Center for Tumor Diseases, Heidelberg 69120, Germany
| | - Melissa C Southey
- Cancer Council Victoria, Cancer Epidemiology Division, Melbourne, VIC 3004, Australia; Monash University, Precision Medicine, School of Clinical Sciences at Monash Health, Clayton, VIC 3168, Australia; The University of Melbourne, Department of Clinical Pathology, Melbourne, VIC 3010, Australia
| | - John J Spinelli
- BC Cancer, Population Oncology, Vancouver, BC V5Z 1G1, Canada; University of British Columbia, School of Population and Public Health, Vancouver, BC V6T 1Z4, Canada
| | - Jennifer Stone
- The University of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, Melbourne, VIC 3010, Australia; Curtin University and University of Western Australia, The Curtin UWA Centre for Genetic Origins of Health and Disease, Perth, WA 6000, Australia
| | - William J Tapper
- University of Southampton, Faculty of Medicine, Southampton SO17 1BJ, UK
| | - Maria Tengström
- University of Eastern Finland, Translational Cancer Research Area, Kuopio 70210, Finland; Kuopio University Hospital, Department of Oncology, Cancer Center, Kuopio 70210, Finland; University of Eastern Finland, Institute of Clinical Medicine, Oncology, Kuopio 70210, Finland
| | - Soo Hwang Teo
- Cancer Research Malaysia, Breast Cancer Research Programme, Subang Jaya, Selangor 47500, Malaysia; University of Malaya, Department of Surgery, Faculty of Medicine, Kuala Lumpur 50603, Malaysia
| | - Mary Beth Terry
- Columbia University, Department of Epidemiology, Mailman School of Public Health, New York, NY 10032, USA
| | - Rob A E M Tollenaar
- Leiden University Medical Center, Department of Surgery, Leiden 2333 ZA, the Netherlands
| | - Ian Tomlinson
- University of Birmingham, Institute of Cancer and Genomic Sciences, Birmingham B15 2TT, UK; University of Oxford, Wellcome Trust Centre for Human Genetics and Oxford NIHR Biomedical Research Centre, Oxford OX3 7BN, UK
| | - Melissa A Troester
- University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Global Public Health and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA
| | - Celine M Vachon
- Mayo Clinic, Department of Health Science Research, Division of Epidemiology, Rochester, MN 55905, USA
| | - Chantal van Ongeval
- Leuven Cancer Institute, University Hospitals Leuven, Leuven Multidisciplinary Breast Center, Department of Radiology, Leuven 3000, Belgium
| | - Elke M van Veen
- University of Manchester, Manchester Academic Health Science Centre, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester M13 9WL, UK; St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, North West Genomics Laboratory Hub, Manchester Centre for Genomic Medicine, Manchester M13 9WL, UK
| | - Robert Winqvist
- University of Oulu, Laboratory of Cancer Genetics and Tumor Biology, Cancer and Translational Medicine Research Unit, Biocenter Oulu, Oulu 90220, Finland; Northern Finland Laboratory Centre Oulu, Laboratory of Cancer Genetics and Tumor Biology, Oulu 90220, Finland
| | - Alicja Wolk
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm 171 77, Sweden; Uppsala University, Department of Surgical Sciences, Uppsala 751 05, Sweden
| | - Wei Zheng
- Vanderbilt University School of Medicine, Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Argyrios Ziogas
- University of California Irvine, Department of Epidemiology, Genetic Epidemiology Research Institute, Irvine, CA 92617, USA
| | - Douglas F Easton
- University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, Cambridge CB1 8RN, UK; University of Cambridge, Centre for Cancer Genetic Epidemiology, Department of Oncology, Cambridge CB1 8RN, UK
| | - Per Hall
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm 171 65, Sweden; Södersjukhuset, Department of Oncology, Stockholm 118 83, Sweden
| | - Marjanka K Schmidt
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Division of Molecular Pathology, Amsterdam 1066 CX, the Netherlands; The Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Division of Psychosocial Research and Epidemiology, Amsterdam 1066 CX, the Netherlands.
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Abstract
Despite decades of laboratory, epidemiological and clinical research, breast cancer incidence continues to rise. Breast cancer remains the leading cancer-related cause of disease burden for women, affecting one in 20 globally and as many as one in eight in high-income countries. Reducing breast cancer incidence will likely require both a population-based approach of reducing exposure to modifiable risk factors and a precision-prevention approach of identifying women at increased risk and targeting them for specific interventions, such as risk-reducing medication. We already have the capacity to estimate an individual woman's breast cancer risk using validated risk assessment models, and the accuracy of these models is likely to continue to improve over time, particularly with inclusion of newer risk factors, such as polygenic risk and mammographic density. Evidence-based risk-reducing medications are cheap, widely available and recommended by professional health bodies; however, widespread implementation of these has proven challenging. The barriers to uptake of, and adherence to, current medications will need to be considered as we deepen our understanding of breast cancer initiation and begin developing and testing novel preventives.
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Affiliation(s)
- Kara L Britt
- Breast Cancer Risk and Prevention Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Kelly-Anne Phillips
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Breast cancer risk based on adapted IBIS prediction model in Slovenian women aged 40-49 years - could it be better? Radiol Oncol 2020; 54:335-340. [PMID: 32614783 PMCID: PMC7409597 DOI: 10.2478/raon-2020-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/07/2020] [Indexed: 01/30/2023] Open
Abstract
Background The aim of the study was to assess the proportion of women that would be classified as at above-average risk of breast cancer based on the 10 year-risk prediction of the Slovenian breast cancer incidence rate (S-IBIS) program in two presumably above-average breast cancer risk populations in age group 40-49 years: (i) women referred for any reason to diagnostic breast centres and (ii) women who were diagnosed with breast cancer aged 40-49 years. Breast cancer is the commonest female cancer in Slovenia, with an incidence rate below European average. The Tyrer-Cuzick breast cancer risk assessment algorithm was recently adapted to S-IBIS. In Slovenia a tailored mammographic screening for women at above average risk in age group 40-49 years is considered in the future. S-IBIS is a possible tool to select population at above-average risk of breast cancer for tailored screening. Patients and methods In 357 healthy women aged 40-49 years referred for any reason to diagnostic breast centres and in 367 female breast cancer patients aged 40-49 years at time of diagnosis 10-years breast cancer risk was calculated using the S-IBIS software. The proportion of women classified as above-average risk of breast cancer was calculated for each subgroup of the study population. Results 48.7% of women in the Breast centre group and 39.2% of patients in the breast cancer group had above-average 10-year breast cancer risk. Positive family history of breast cancer was more prevalent in the Breast centre group (p < 0.05). Conclusions Inclusion of additional risk factors into the S-IBIS is warranted in the populations with breast cancer incidence below European average to reliably stratify women into breast cancer risk groups.
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Gallagher S, Hughes E, Wagner S, Tshiaba P, Rosenthal E, Roa BB, Kurian AW, Domchek SM, Garber J, Lancaster J, Weitzel JN, Gutin A, Lanchbury JS, Robson M. Association of a Polygenic Risk Score With Breast Cancer Among Women Carriers of High- and Moderate-Risk Breast Cancer Genes. JAMA Netw Open 2020; 3:e208501. [PMID: 32609350 PMCID: PMC7330720 DOI: 10.1001/jamanetworkopen.2020.8501] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/13/2020] [Indexed: 12/11/2022] Open
Abstract
Importance To date, few studies have examined the extent to which polygenic single-nucleotide variation (SNV) (formerly single-nucleotide polymorphism) scores modify risk for carriers of pathogenic variants (PVs) in breast cancer susceptibility genes. In previous reports, polygenic risk modification was reduced for BRCA1 and BRCA2 PV carriers compared with noncarriers, but limited information is available for carriers of CHEK2, ATM, or PALB2 PVs. Objective To examine an 86-SNV polygenic risk score (PRS) for BRCA1, BRCA2, CHEK2, ATM, and PALB2 PV carriers. Design, Setting, and Participants A retrospective case-control study using data on 150 962 women tested with a multigene hereditary cancer panel between July 19, 2016, and January 11, 2019, was conducted in a commercial testing laboratory. Participants included women of European ancestry between the ages of 18 and 84 years. Main Outcomes and Measures Multivariable logistic regression was used to examine the association of the 86-SNV score with invasive breast cancer after adjusting for age, ancestry, and personal and/or family cancer history. Effect sizes, expressed as standardized odds ratios (ORs) with 95% CIs, were assessed for carriers of PVs in each gene as well as for noncarriers. Results The median age at hereditary cancer testing of the population was 48 years (range, 18-84 years); there were 141 160 noncarriers in addition to carriers of BRCA1 (n = 2249), BRCA2 (n = 2638), CHEK2 (n = 2564), ATM (n = 1445), and PALB2 (n = 906) PVs included in the analysis. The 86-SNV score was associated with breast cancer risk in each of the carrier populations (P < 1 × 10-4). Stratification was more pronounced for noncarriers (OR, 1.47; 95% CI, 1.45-1.49) and CHEK2 PV carriers (OR, 1.49; 95% CI, 1.36-1.64) than for carriers of BRCA1 (OR, 1.20; 95% CI, 1.10-1.32) or BRCA2 (OR, 1.23; 95% CI, 1.12-1.34) PVs. Odds ratios for ATM (OR, 1.37; 95% CI, 1.21-1.55) and PALB2 (OR, 1.34; 95% CI, 1.16-1.55) PV carrier populations were intermediate between those for BRCA1/2 and CHEK2 noncarriers. Conclusions and Relevance In this study, the 86-SNV score was associated with modified risk for carriers of BRCA1, BRCA2, CHEK2, ATM, and PALB2 PVs. This finding supports previous reports of reduced PRS stratification for BRCA1 and BRCA2 PV carriers compared with noncarriers. Modification of risk in CHEK2 carriers associated with the 86-SNV score appeared to be similar to that observed in women without a PV. Larger studies are needed to provide more refined estimates of polygenic modification of risk for women with PVs in other moderate-penetrance genes.
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Affiliation(s)
| | | | | | | | | | | | | | - Susan M. Domchek
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Judy Garber
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Johnathan Lancaster
- Myriad Genetics Inc, Salt Lake City, Utah
- Regeneron Pharmaceuticals Inc, Tarrytown, New York
| | | | | | | | - Mark Robson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Woof VG, Ruane H, French DP, Ulph F, Qureshi N, Khan N, Evans DG, Donnelly LS. The introduction of risk stratified screening into the NHS breast screening Programme: views from British-Pakistani women. BMC Cancer 2020; 20:452. [PMID: 32434564 PMCID: PMC7240981 DOI: 10.1186/s12885-020-06959-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND UK national guidelines suggest women at high-risk of breast cancer should be offered more frequent screening or preventative medications. Currently, only 1 in 6 high-risk women are identified. One route to identify more high-risk women is via multifactorial risk assessment as part of the UK's NHS Breast Screening Programme (NHSBSP). As lower socioeconomic and minority ethnic populations continue to experience barriers to screening, it is important that any new service does not exacerbate issues further. To inform service development, this study explored views of women from underserved backgrounds regarding the introduction of risk stratification into the NHSBSP. METHODS Nineteen semi-structured interviews were conducted with British-Pakistani women from low socioeconomic backgrounds from East Lancashire, UK. Fourteen interviews were conducted via an interpreter. RESULTS Thematic analysis produced three themes. Attitudes toward risk awareness concerns the positive views women have toward the idea of receiving personalised breast cancer risk information. Anticipated barriers to accessibility emphasises the difficulties associated with women's limited English skills for accessing information, and their I.T proficiency for completing an online risk assessment questionnaire. Acceptability of risk communication strategy highlights the diversity of opinion regarding the suitability of receiving risk results via letter, with the option for support from a healthcare professional deemed essential. CONCLUSIONS The idea of risk stratification was favourable amongst this underserved community. To avoid exacerbating inequities, this new service should provide information in multiple languages and modalities and offer women the opportunity to speak to a healthcare professional about risk. This service should also enable completion of personal risk information via paper questionnaires, as well as online.
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Affiliation(s)
- Victoria G Woof
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Room 1.13, Coupland 1, Coupland Street, Off Oxford Road, Manchester, M13 9PL, UK.
| | - Helen Ruane
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust (MFT), Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
| | - David P French
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Room 1.13, Coupland 1, Coupland Street, Off Oxford Road, Manchester, M13 9PL, UK
| | - Fiona Ulph
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC, Room 1.13, Coupland 1, Coupland Street, Off Oxford Road, Manchester, M13 9PL, UK
| | - Nadeem Qureshi
- NIHR School of Primary Care, School of Medicine, Tower Building, University Park, Nottingham, NG7 2RD, UK
| | - Nasaim Khan
- Department of Genomic Medicine, Division of Evolution and Genomic Science, MAHSC, University of Manchester, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - D Gareth Evans
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust (MFT), Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK.,Department of Genomic Medicine, Division of Evolution and Genomic Science, MAHSC, University of Manchester, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - Louise S Donnelly
- Nightingale & Prevent Breast Cancer Research Unit, Manchester University NHS Foundation Trust (MFT), Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
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