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Werneth CM, Patel ZS, Thompson MS, Blattnig SR, Huff JL. Considering clonal hematopoiesis of indeterminate potential in space radiation risk analysis for hematologic cancers and cardiovascular disease. COMMUNICATIONS MEDICINE 2024; 4:105. [PMID: 38862635 PMCID: PMC11166645 DOI: 10.1038/s43856-023-00408-4] [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: 05/05/2023] [Accepted: 11/16/2023] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Expanding human presence in space through long-duration exploration missions and commercial space operations warrants improvements in approaches for quantifying crew space radiation health risks. Currently, risk assessment models for radiogenic cancer and cardiovascular disease consider age, sex, and tobacco use, but do not incorporate other modifiable (e.g., body weight, physical activity, diet, environment) and non-modifiable individual risk factors (e.g., genetics, medical history, race/ethnicity, family history) that may greatly influence crew health both in-mission and long-term. For example, clonal hematopoiesis of indeterminate potential (CHIP) is a relatively common age-related condition that is an emerging risk factor for a variety of diseases including cardiovascular disease and cancer. CHIP carrier status may therefore exacerbate health risks associated with space radiation exposure. METHODS In the present study, published CHIP hazard ratios were used to modify background hazard rates for coronary heart disease, stroke, and hematologic cancers in the National Aeronautics and Space Administration space radiation risk assessment model. The risk of radiation exposure-induced death for these endpoints was projected for a future Mars exploration mission scenario. RESULTS Here we show appreciable increases in the lifetime risk of exposure-induced death for hematologic malignancies, coronary heart disease, and stroke, which are observed as a function of age after radiation exposure for male and female crew members that are directly attributable to the elevated health risks for CHIP carriers. CONCLUSIONS We discuss the importance of evaluating individual risk factors such as CHIP as part of a comprehensive space radiation risk assessment strategy aimed at effective risk communication and disease surveillance for astronauts embarking on future exploration missions.
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Affiliation(s)
| | - Zarana S Patel
- Center for Scientific Review, National Institutes of Health, Bethesda, MD, USA
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2
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Psychotic disorders as a framework for precision psychiatry. Nat Rev Neurol 2023; 19:221-234. [PMID: 36879033 DOI: 10.1038/s41582-023-00779-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 03/08/2023]
Abstract
People with psychotic disorders can show marked interindividual variations in the onset of illness, responses to treatment and relapse, but they receive broadly similar clinical care. Precision psychiatry is an approach that aims to stratify people with a given disorder according to different clinical outcomes and tailor treatment to their individual needs. At present, interindividual differences in outcomes of psychotic disorders are difficult to predict on the basis of clinical assessment alone. Therefore, current research in psychosis seeks to build models that predict outcomes by integrating clinical information with a range of biological measures. Here, we review recent progress in the application of precision psychiatry to psychotic disorders and consider the challenges associated with implementing this approach in clinical practice.
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3
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Jackson T, Carmichael C, Lovett K, Scott M, Shakya S, Sotak M. Approach to the patient with a palpable breast mass. JAAPA 2022; 35:22-28. [PMID: 36069843 DOI: 10.1097/01.jaa.0000873772.13779.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Breast mass is a common finding in patients presenting to primary care, women's health, or urgent care clinics. There are multiple etiologies that can cause a palpable breast mass both benign and malignant. PAs must know how to approach a patient with a palpable breast mass as well as what appropriate diagnostic evaluation is needed.
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Affiliation(s)
- Toni Jackson
- Toni Jackson is an assistant professor in the PA program at Wake Forest School of Medicine in Winston-Salem, N.C. At the time this article was written, Caroline Carmichael, Katie Lovett, Morgan Scott, Sabrina Shakya , and Megan Sotak were students in the PA program at Wake Forest School of Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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4
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Lehman CD, Mercaldo S, Lamb LR, King TA, Ellisen LW, Specht M, Tamimi RM. Deep Learning vs Traditional Breast Cancer Risk Models to Support Risk-Based Mammography Screening. J Natl Cancer Inst 2022; 114:1355-1363. [PMID: 35876790 PMCID: PMC9552206 DOI: 10.1093/jnci/djac142] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/11/2022] [Accepted: 07/01/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Deep learning breast cancer risk models demonstrate improved accuracy compared with traditional risk models but have not been prospectively tested. We compared the accuracy of a deep learning risk score derived from the patient's prior mammogram to traditional risk scores to prospectively identify patients with cancer in a cohort due for screening. METHODS We collected data on 119 139 bilateral screening mammograms in 57 617 consecutive patients screened at 5 facilities between September 18, 2017, and February 1, 2021. Patient demographics were retrieved from electronic medical records, cancer outcomes determined through regional tumor registry linkage, and comparisons made across risk models using Wilcoxon and Pearson χ2 2-sided tests. Deep learning, Tyrer-Cuzick, and National Cancer Institute Breast Cancer Risk Assessment Tool (NCI BCRAT) risk models were compared with respect to performance metrics and area under the receiver operating characteristic curves. RESULTS Cancers detected per thousand patients screened were higher in patients at increased risk by the deep learning model (8.6, 95% confidence interval [CI] = 7.9 to 9.4) compared with Tyrer-Cuzick (4.4, 95% CI = 3.9 to 4.9) and NCI BCRAT (3.8, 95% CI = 3.3 to 4.3) models (P < .001). Area under the receiver operating characteristic curves of the deep learning model (0.68, 95% CI = 0.66 to 0.70) was higher compared with Tyrer-Cuzick (0.57, 95% CI = 0.54 to 0.60) and NCI BCRAT (0.57, 95% CI = 0.54 to 0.60) models. Simulated screening of the top 50th percentile risk by the deep learning model captured statistically significantly more patients with cancer compared with Tyrer-Cuzick and NCI BCRAT models (P < .001). CONCLUSIONS A deep learning model to assess breast cancer risk can support feasible and effective risk-based screening and is superior to traditional models to identify patients destined to develop cancer in large screening cohorts.
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Affiliation(s)
- Constance D Lehman
- Correspondence to: Constance D. Lehman, MD, PhD, Massachusetts General
Hospital, Harvard Medical School, Radiology, 55 Fruit Street, Boston, MA 02114 USA
(e-mail: )
| | - Sarah Mercaldo
- Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Radiology, Boston, MA, USA
| | - Leslie R Lamb
- Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Radiology, Boston, MA, USA
| | - Tari A King
- Harvard Medical School, Surgery, Boston, MA, USA,Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA,
USA
| | - Leif W Ellisen
- Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Medicine, Boston, MA, USA
| | - Michelle Specht
- Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Surgery, Boston, MA, USA
| | - Rulla M Tamimi
- Weill Cornell Medicine, Epidemiology and Population Health
Sciences, New York, NY, USA
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5
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Moorthie S, Babb de Villiers C, Burton H, Kroese M, Antoniou AC, Bhattacharjee P, Garcia-Closas M, Hall P, Schmidt MK. Towards implementation of comprehensive breast cancer risk prediction tools in health care for personalised prevention. Prev Med 2022; 159:107075. [PMID: 35526672 DOI: 10.1016/j.ypmed.2022.107075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/05/2022] [Accepted: 05/02/2022] [Indexed: 12/24/2022]
Abstract
Advances in knowledge about breast cancer risk factors have led to the development of more comprehensive risk models. These integrate information on a variety of risk factors such as lifestyle, genetics, family history, and breast density. These risk models have the potential to deliver more personalised breast cancer prevention. This is through improving accuracy of risk estimates, enabling more effective targeting of preventive options and creating novel prevention pathways through enabling risk estimation in a wider variety of populations than currently possible. The systematic use of risk tools as part of population screening programmes is one such example. A clear understanding of how such tools can contribute to the goal of personalised prevention can aid in understanding and addressing barriers to implementation. In this paper we describe how emerging models, and their associated tools can contribute to the goal of personalised healthcare for breast cancer through health promotion, early disease detection (screening) and improved management of women at higher risk of disease. We outline how addressing specific challenges on the level of communication, evidence, evaluation, regulation, and acceptance, can facilitate implementation and uptake.
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Affiliation(s)
- Sowmiya Moorthie
- PHG Foundation, University of Cambridge, Cambridge, UK; Cambridge Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge CB2 0SR, United Kingdom.
| | | | - Hilary Burton
- PHG Foundation, University of Cambridge, Cambridge, UK
| | - Mark Kroese
- PHG Foundation, University of Cambridge, Cambridge, UK
| | - Antonis C Antoniou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Proteeti Bhattacharjee
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Montserrat Garcia-Closas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda, USA
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
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6
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Hurson AN, Pal Choudhury P, Gao C, Hüsing A, Eriksson M, Shi M, Jones ME, Evans DGR, Milne RL, Gaudet MM, Vachon CM, Chasman DI, Easton DF, Schmidt MK, Kraft P, Garcia-Closas M, Chatterjee N. Prospective evaluation of a breast-cancer risk model integrating classical risk factors and polygenic risk in 15 cohorts from six countries. Int J Epidemiol 2022; 50:1897-1911. [PMID: 34999890 PMCID: PMC8743128 DOI: 10.1093/ije/dyab036] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 02/19/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Rigorous evaluation of the calibration and discrimination of breast-cancer risk-prediction models in prospective cohorts is critical for applications under clinical guidelines. We comprehensively evaluated an integrated model incorporating classical risk factors and a 313-variant polygenic risk score (PRS) to predict breast-cancer risk. METHODS Fifteen prospective cohorts from six countries with 239 340 women (7646 incident breast-cancer cases) of European ancestry aged 19-75 years were included. Calibration of 5-year risk was assessed by comparing expected and observed proportions of cases overall and within risk categories. Risk stratification for women of European ancestry aged 50-70 years in those countries was evaluated by the proportion of women and future cases crossing clinically relevant risk thresholds. RESULTS Among women <50 years old, the median (range) expected-to-observed ratio for the integrated model across 15 cohorts was 0.9 (0.7-1.0) overall and 0.9 (0.7-1.4) at the highest-risk decile; among women ≥50 years old, these were 1.0 (0.7-1.3) and 1.2 (0.7-1.6), respectively. The proportion of women identified above a 3% 5-year risk threshold (used for recommending risk-reducing medications in the USA) ranged from 7.0% in Germany (∼841 000 of 12 million) to 17.7% in the USA (∼5.3 of 30 million). At this threshold, 14.7% of US women were reclassified by adding the PRS to classical risk factors, with identification of 12.2% of additional future cases. CONCLUSION Integrating a 313-variant PRS with classical risk factors can improve the identification of European-ancestry women at elevated risk who could benefit from targeted risk-reducing strategies under current clinical guidelines.
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Affiliation(s)
- Amber N Hurson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Parichoy Pal Choudhury
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Chi Gao
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Karolinska Univ Hospital, Stockholm, Sweden
| | - Min Shi
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Michael E Jones
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - D Gareth R Evans
- Division of Evolution and Genomic Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester NIHR Biomedical Research Centre, Manchester University Hospitals NHS, Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Mia M Gaudet
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, USA
| | - Celine M Vachon
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute—Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Peter Kraft
- Program in Genetic Epidemiology and Statistical Genetics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Nilanjan Chatterjee
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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7
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Yiangou K, Kyriacou K, Kakouri E, Marcou Y, Panayiotidis MI, Loizidou MA, Hadjisavvas A, Michailidou K. Combination of a 15-SNP Polygenic Risk Score and Classical Risk Factors for the Prediction of Breast Cancer Risk in Cypriot Women. Cancers (Basel) 2021; 13:cancers13184568. [PMID: 34572793 PMCID: PMC8468424 DOI: 10.3390/cancers13184568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Breast cancer is the most commonly diagnosed type of cancer in women worldwide. Stratification of women based on their individual breast cancer risk could guide targeted preventative strategies and population screening. Integrated models that combine the effects of a polygenic risk score (PRS) with classical breast cancer risk factors could provide an individualized breast-cancer risk estimation. Although various studies have extensively evaluated the performance of such integrated models in populations of European ancestry, no previous studies have included individuals of Greek-Cypriot origin. To this end, we have assessed the predictive performance of a 15-SNP PRS (PRS15), in combination with classical breast-cancer risk factors, in women of Greek-Cypriot origin. This proof-of-concept study suggests that models combining genetic data with classical risk factors may be used in the future for the prediction of breast-cancer risk and, therefore, supports their potential clinical utility for targeted preventative strategies in Cypriot women. Abstract The PRS combines multiplicatively the effects of common low-risk single nucleotide polymorphisms (SNPs) and has the potential to be used for the estimation of an individual’s risk for a trait or disease. PRS has been successfully implemented for the prediction of breast cancer risk. The combination of PRS with classical breast cancer risk factors provides a more comprehensive risk estimation and could, thus, improve risk stratification and personalized preventative strategies. In this study, we assessed the predictive performance of the combined effect of PRS15 with classical breast-cancer risk factors in Cypriot women using 1109 cases and 1177 controls from the MASTOS study. The PRS15 was significantly associated with an increased breast cancer risk in Cypriot women OR (95% CI) 1.66 (1.25–2.19). The integrated risk model obtained an AUC (95% CI) 0.70 (0.67–0.72) and had the ability to stratify women according to their disease status at the extreme deciles. These results provide evidence that the combination of PRS with classical risk factors may be used in the future for the stratification of Cypriot women based on their disease risk, and support its potential clinical utility for targeted preventative actions and population screening.
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Affiliation(s)
- Kristia Yiangou
- Department of Cancer Genetics, Therapeutics and Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus; (K.Y.); (K.K.); (M.I.P.); (M.A.L.)
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
| | - Kyriacos Kyriacou
- Department of Cancer Genetics, Therapeutics and Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus; (K.Y.); (K.K.); (M.I.P.); (M.A.L.)
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
| | - Eleni Kakouri
- Department of Medical Oncology, Bank of Cyprus Oncology Center, Nicosia 2012, Cyprus; (E.K.); (Y.M.)
| | - Yiola Marcou
- Department of Medical Oncology, Bank of Cyprus Oncology Center, Nicosia 2012, Cyprus; (E.K.); (Y.M.)
| | - Mihalis I. Panayiotidis
- Department of Cancer Genetics, Therapeutics and Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus; (K.Y.); (K.K.); (M.I.P.); (M.A.L.)
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
| | - Maria A. Loizidou
- Department of Cancer Genetics, Therapeutics and Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus; (K.Y.); (K.K.); (M.I.P.); (M.A.L.)
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
| | - Andreas Hadjisavvas
- Department of Cancer Genetics, Therapeutics and Ultrastructural Pathology, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus; (K.Y.); (K.K.); (M.I.P.); (M.A.L.)
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
- Correspondence: (A.H.); (K.M.)
| | - Kyriaki Michailidou
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
- Biostatistics Unit, The Cyprus Institute of Neurology and Genetics, Nicosia 2371, Cyprus
- Correspondence: (A.H.); (K.M.)
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8
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Pal Choudhury P, Wilcox AN, Brook MN, Zhang Y, Ahearn T, Orr N, Coulson P, Schoemaker MJ, Jones ME, Gail MH, Swerdlow AJ, Chatterjee N, Garcia-Closas M. Comparative Validation of Breast Cancer Risk Prediction Models and Projections for Future Risk Stratification. J Natl Cancer Inst 2020; 112:278-285. [PMID: 31165158 DOI: 10.1093/jnci/djz113] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/31/2019] [Accepted: 05/29/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND External validation of risk models is critical for risk-stratified breast cancer prevention. We used the Individualized Coherent Absolute Risk Estimation (iCARE) as a flexible tool for risk model development and comparative model validation and to make projections for population risk stratification. METHODS Performance of two recently developed models, one based on the Breast and Prostate Cancer Cohort Consortium analysis (iCARE-BPC3) and another based on a literature review (iCARE-Lit), were compared with two established models (Breast Cancer Risk Assessment Tool and International Breast Cancer Intervention Study Model) based on classical risk factors in a UK-based cohort of 64 874 white non-Hispanic women (863 patients) age 35-74 years. Risk projections in a target population of US white non-Hispanic women age 50-70 years assessed potential improvements in risk stratification by adding mammographic breast density (MD) and polygenic risk score (PRS). RESULTS The best calibrated models were iCARE-Lit (expected to observed number of cases [E/O] = 0.98, 95% confidence interval [CI] = 0.87 to 1.11) for women younger than 50 years, and iCARE-BPC3 (E/O = 1.00, 95% CI = 0.93 to 1.09) for women 50 years or older. Risk projections using iCARE-BPC3 indicated classical risk factors can identify approximately 500 000 women at moderate to high risk (>3% 5-year risk) in the target population. Addition of MD and a 313-variant PRS is expected to increase this number to approximately 3.5 million women, and among them, approximately 153 000 are expected to develop invasive breast cancer within 5 years. CONCLUSIONS iCARE models based on classical risk factors perform similarly to or better than BCRAT or IBIS in white non-Hispanic women. Addition of MD and PRS can lead to substantial improvements in risk stratification. However, these integrated models require independent prospective validation before broad clinical applications.
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Affiliation(s)
| | - Amber N Wilcox
- Johns Hopkins University, Baltimore, MD.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda
| | | | - Yan Zhang
- Department of Biostatistics, Bloomberg School of Public Health
| | - Thomas Ahearn
- Johns Hopkins University, Baltimore, MD.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda
| | - Nick Orr
- Department of Biostatistics, Bloomberg School of Public Health.,Department of Oncology, School of Medicine.,Division of Breast Cancer Research, The Institute of Cancer Research, London, UK.,Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | | | | | | | - Mitchell H Gail
- Johns Hopkins University, Baltimore, MD.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology.,Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | | | - Montserrat Garcia-Closas
- Johns Hopkins University, Baltimore, MD.,Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda
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9
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Gierach GL, Choudhury PP, García-Closas M. Toward Risk-Stratified Breast Cancer Screening: Considerations for Changes in Screening Guidelines. JAMA Oncol 2020; 6:31-33. [PMID: 31725821 PMCID: PMC8170848 DOI: 10.1001/jamaoncol.2019.3820] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Gretchen L Gierach
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Parichoy Pal Choudhury
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Montserrat García-Closas
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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