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Zirpoli GR, Pfeiffer RM, Bertrand KA, Huo D, Lunetta KL, Palmer JR. Addition of polygenic risk score to a risk calculator for prediction of breast cancer in US Black women. Breast Cancer Res 2024; 26:2. [PMID: 38167144 PMCID: PMC10763003 DOI: 10.1186/s13058-023-01748-8] [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: 08/22/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Previous work in European ancestry populations has shown that adding a polygenic risk score (PRS) to breast cancer risk prediction models based on epidemiologic factors results in better discriminatory performance as measured by the AUC (area under the curve). Following publication of the first PRS to perform well in women of African ancestry (AA-PRS), we conducted an external validation of the AA-PRS and then evaluated the addition of the AA-PRS to a risk calculator for incident breast cancer in Black women based on epidemiologic factors (BWHS model). METHODS Data from the Black Women's Health Study, an ongoing prospective cohort study of 59,000 US Black women followed by biennial questionnaire since 1995, were used to calculate AUCs and 95% confidence intervals (CIs) for discriminatory accuracy of the BWHS model, the AA-PRS alone, and a new model that combined them. Analyses were based on data from 922 women with invasive breast cancer and 1844 age-matched controls. RESULTS AUCs were 0.577 (95% CI 0.556-0.598) for the BWHS model and 0.584 (95% CI 0.563-0.605) for the AA-PRS. For a model that combined estimates from the questionnaire-based BWHS model with the PRS, the AUC increased to 0.623 (95% CI 0.603-0.644). CONCLUSIONS This combined model represents a step forward for personalized breast cancer preventive care for US Black women, as its performance metrics are similar to those from models in other populations. Use of this new model may mitigate exacerbation of breast cancer disparities if and when it becomes feasible to include a PRS in routine health care decision-making.
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Affiliation(s)
- Gary R Zirpoli
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
- Division of Cancer Epidemiology and Biostatistics, National Cancer Institute, Bethesda, USA.
| | - Kimberly A Bertrand
- Slone Epidemiology Center at Boston University, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Dezheng Huo
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
- Center for Clinical Cancer Genetics & Global Health, The University of Chicago, Chicago, IL, USA
| | - Kathryn L Lunetta
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA.
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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2
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Fatapour Y, Brody JP. Genetic Risk Scores and Missing Heritability in Ovarian Cancer. Genes (Basel) 2023; 14:genes14030762. [PMID: 36981032 PMCID: PMC10048518 DOI: 10.3390/genes14030762] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Ovarian cancers are curable by surgical resection when discovered early. Unfortunately, most ovarian cancers are diagnosed in the later stages. One strategy to identify early ovarian tumors is to screen women who have the highest risk. This opinion article summarizes the accuracy of different methods used to assess the risk of developing ovarian cancer, including family history, BRCA genetic tests, and polygenic risk scores. The accuracy of these is compared to the maximum theoretical accuracy, revealing a substantial gap. We suggest that this gap, or missing heritability, could be caused by epistatic interactions between genes. An alternative approach to computing genetic risk scores, using chromosomal-scale length variation should incorporate epistatic interactions. Future research in this area should focus on this and other alternative methods of characterizing genomes.
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Affiliation(s)
- Yasaman Fatapour
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
| | - James P Brody
- Department of Biomedical Engineering, University of California, Irvine, CA 92697, USA
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3
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Chotiyarnwong P, McCloskey EV, Harvey NC, Lorentzon M, Prieto-Alhambra D, Abrahamsen B, Adachi JD, Borgström F, Bruyere O, Carey JJ, Clark P, Cooper C, Curtis EM, Dennison E, Diaz-Curiel M, Dimai HP, Grigorie D, Hiligsmann M, Khashayar P, Lewiecki EM, Lips P, Lorenc RS, Ortolani S, Papaioannou A, Silverman S, Sosa M, Szulc P, Ward KA, Yoshimura N, Kanis JA. Is it time to consider population screening for fracture risk in postmenopausal women? A position paper from the International Osteoporosis Foundation Epidemiology/Quality of Life Working Group. Arch Osteoporos 2022; 17:87. [PMID: 35763133 PMCID: PMC9239944 DOI: 10.1007/s11657-022-01117-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 02/03/2023]
Abstract
The IOF Epidemiology and Quality of Life Working Group has reviewed the potential role of population screening for high hip fracture risk against well-established criteria. The report concludes that such an approach should strongly be considered in many health care systems to reduce the burden of hip fractures. INTRODUCTION The burden of long-term osteoporosis management falls on primary care in most healthcare systems. However, a wide and stable treatment gap exists in many such settings; most of which appears to be secondary to a lack of awareness of fracture risk. Screening is a public health measure for the purpose of identifying individuals who are likely to benefit from further investigations and/or treatment to reduce the risk of a disease or its complications. The purpose of this report was to review the evidence for a potential screening programme to identify postmenopausal women at increased risk of hip fracture. METHODS The approach took well-established criteria for the development of a screening program, adapted by the UK National Screening Committee, and sought the opinion of 20 members of the International Osteoporosis Foundation's Working Group on Epidemiology and Quality of Life as to whether each criterion was met (yes, partial or no). For each criterion, the evidence base was then reviewed and summarized. RESULTS AND CONCLUSION The report concludes that evidence supports the proposal that screening for high fracture risk in primary care should strongly be considered for incorporation into many health care systems to reduce the burden of fractures, particularly hip fractures. The key remaining hurdles to overcome are engagement with primary care healthcare professionals, and the implementation of systems that facilitate and maintain the screening program.
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Affiliation(s)
- P Chotiyarnwong
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
- Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - E V McCloskey
- Department of Oncology & Metabolism, Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK.
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Lorentzon
- University of Gothenburg, Gothenburg, Sweden
- Australian Catholic University, Melbourne, Australia
| | - D Prieto-Alhambra
- Oxford NIHR Biomedical Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- GREMPAL (Grup de Recerca en Malalties Prevalents de L'Aparell Locomotor) Research Group, CIBERFes and Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona and Instituto de Salud Carlos III, Gran Via de Les Corts Catalanes, 591 Atico, 08007, Barcelona, Spain
| | - B Abrahamsen
- Department of Clinical Research, Odense Patient Data Exploratory Network, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - J D Adachi
- Department of Medicine, Michael G DeGroote School of Medicine, St Joseph's Healthcare-McMaster University, Hamilton, ON, Canada
| | - F Borgström
- Quantify Research, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - O Bruyere
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J J Carey
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - P Clark
- Clinical Epidemiology Unit of Hospital Infantil de México Federico Gómez-Faculty of Medicine, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - E Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - M Diaz-Curiel
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - H P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - D Grigorie
- Carol Davila University of Medicine, Bucharest, Romania
- Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania
| | - M Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - P Khashayar
- Center for Microsystems Technology, Imec and Ghent University, 9050, Ghent, Belgium
| | - E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - P Lips
- Department of Internal Medicine, Endocrine Section & Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R S Lorenc
- Multidisciplinary Osteoporosis Forum, SOMED, Warsaw, Poland
| | - S Ortolani
- IRCCS Istituto Auxologico, UO Endocrinologia E Malattie del Metabolismo, Milano, Italy
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- GERAS Centre for Aging Research, Hamilton, ON, Canada
| | - S Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - M Sosa
- Bone Metabolic Unit, University of Las Palmas de Gran Canaria, Hospital University Insular, Las Palmas, Gran Canaria, Spain
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - K A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22Nd Century Medical and Research Center, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - J A Kanis
- Centre for Metabolic Bone Diseases, Northern General Hospital, University of Sheffield, Herries Road, Sheffield, S5 7AU, UK
- Australian Catholic University, Melbourne, Australia
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4
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McCloskey EV, Harvey NC, Johansson H, Lorentzon M, Liu E, Vandenput L, Leslie WD, Kanis JA. Fracture risk assessment by the FRAX model. Climacteric 2022; 25:22-28. [PMID: 34319212 DOI: 10.1080/13697137.2021.1945027] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
The introduction of the FRAX algorithms has facilitated the assessment of fracture risk on the basis of fracture probability. FRAX integrates the influence of several well-validated risk factors for fracture with or without the use of bone mineral density. Since age-specific rates of fracture and death differ across the world, FRAX models are calibrated with regard to the epidemiology of hip fracture (preferably from national sources) and mortality (usually United Nations sources). Models are currently available for 73 nations or territories covering more than 80% of the world population. FRAX has been incorporated into more than 80 guidelines worldwide, although the nature of this application has been heterogeneous. The limitations of FRAX have been extensively reviewed. Arithmetic procedures have been proposed in order to address some of these limitations, which can be applied to conventional FRAX estimates to accommodate knowledge of dose exposure to glucocorticoids, concurrent data on lumbar spine bone mineral density, information on trabecular bone score, hip axis length, falls history, type 2 diabetes, immigration status and recency of prior fracture.
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Affiliation(s)
- E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, VIC, Australia
| | - M Lorentzon
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Sweden
| | - E Liu
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, VIC, Australia
| | - L Vandenput
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, VIC, Australia
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Sweden
| | - W D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, VIC, Australia
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5
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Validation of Breast Cancer Risk Models by Race/Ethnicity, Family History and Molecular Subtypes. Cancers (Basel) 2021; 14:cancers14010045. [PMID: 35008209 PMCID: PMC8750569 DOI: 10.3390/cancers14010045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/09/2021] [Accepted: 12/20/2021] [Indexed: 12/28/2022] Open
Abstract
Simple Summary Several statistical models exist to predict a person’s risk of breast cancer. Risk assessment models can guide cancer screening approaches by identifying individuals who would benefit from additional screening. In this study, we compared the performance of four models in predicting the 5-year risk of breast cancer in a cohort of women aged 40–84 years who underwent screening mammography at three large health systems. Models showed comparable discrimination (ability to distinguish between cases and non-cases) and calibration (ability to accurately predict risk) overall, with no difference by race. Model discrimination was poorer for some cancer subtypes, and better for women with high BMI. The combined BRCAPRO+BCRAT model had improved calibration and discrimination among women with a family history of breast cancer. Our results can inform risk-based screening approaches by identifying women at a high risk of breast cancer. Abstract (1) Background: The purpose of this study is to compare the performance of four breast cancer risk prediction models by race, molecular subtype, family history of breast cancer, age, and BMI. (2) Methods: Using a cohort of women aged 40–84 without prior history of breast cancer who underwent screening mammography from 2006 to 2015, we generated breast cancer risk estimates using the Breast Cancer Risk Assessment tool (BCRAT), BRCAPRO, Breast Cancer Surveillance Consortium (BCSC) and combined BRCAPRO+BCRAT models. Model calibration and discrimination were compared using observed-to-expected ratios (O/E) and the area under the receiver operator curve (AUC) among patients with at least five years of follow-up. (3) Results: We observed comparable discrimination and calibration across models. There was no significant difference in model performance between Black and White women. Model discrimination was poorer for HER2+ and triple-negative subtypes compared with ER/PR+HER2−. The BRCAPRO+BCRAT model displayed improved calibration and discrimination compared to BRCAPRO among women with a family history of breast cancer. Across models, discriminatory accuracy was greater among obese than non-obese women. When defining high risk as a 5-year risk of 1.67% or greater, models demonstrated discordance in 2.9% to 19.7% of patients. (4) Conclusions: Our results can inform the implementation of risk assessment and risk-based screening among women undergoing screening mammography.
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McCarthy AM, Guan Z, Welch M, Griffin ME, Sippo DA, Deng Z, Coopey SB, Acar A, Semine A, Parmigiani G, Braun D, Hughes KS. Performance of Breast Cancer Risk-Assessment Models in a Large Mammography Cohort. J Natl Cancer Inst 2021; 112:489-497. [PMID: 31556450 DOI: 10.1093/jnci/djz177] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/23/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Several breast cancer risk-assessment models exist. Few studies have evaluated predictive accuracy of multiple models in large screening populations. METHODS We evaluated the performance of the BRCAPRO, Gail, Claus, Breast Cancer Surveillance Consortium (BCSC), and Tyrer-Cuzick models in predicting risk of breast cancer over 6 years among 35 921 women aged 40-84 years who underwent mammography screening at Newton-Wellesley Hospital from 2007 to 2009. We assessed model discrimination using the area under the receiver operating characteristic curve (AUC) and assessed calibration by comparing the ratio of observed-to-expected (O/E) cases. We calculated the square root of the Brier score and positive and negative predictive values of each model. RESULTS Our results confirmed the good calibration and comparable moderate discrimination of the BRCAPRO, Gail, Tyrer-Cuzick, and BCSC models. The Gail model had slightly better O/E ratio and AUC (O/E = 0.98, 95% confidence interval [CI] = 0.91 to 1.06, AUC = 0.64, 95% CI = 0.61 to 0.65) compared with BRCAPRO (O/E = 0.94, 95% CI = 0.88 to 1.02, AUC = 0.61, 95% CI = 0.59 to 0.63) and Tyrer-Cuzick (version 8, O/E = 0.84, 95% CI = 0.79 to 0.91, AUC = 0.62, 95% 0.60 to 0.64) in the full study population, and the BCSC model had the highest AUC among women with available breast density information (O/E = 0.97, 95% CI = 0.89 to 1.05, AUC = 0.64, 95% CI = 0.62 to 0.66). All models had poorer predictive accuracy for human epidermal growth factor receptor 2 positive and triple-negative breast cancers than hormone receptor positive human epidermal growth factor receptor 2 negative breast cancers. CONCLUSIONS In a large cohort of patients undergoing mammography screening, existing risk prediction models had similar, moderate predictive accuracy and good calibration overall. Models that incorporate additional genetic and nongenetic risk factors and estimate risk of tumor subtypes may further improve breast cancer risk prediction.
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Affiliation(s)
- Anne Marie McCarthy
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Zoe Guan
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, MA.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Michaela Welch
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Molly E Griffin
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Dorothy A Sippo
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Zhengyi Deng
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Suzanne B Coopey
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
| | - Ahmet Acar
- Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Alan Semine
- Department of Radiology, Newton-Wellesley Hospital, Newton, MA
| | - Giovanni Parmigiani
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, MA.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Danielle Braun
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, MA.,Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Kevin S Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Boston, MA
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7
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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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8
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Sciaraffa T, Guido B, Khan SA, Kulkarni S. Breast cancer risk assessment and management programs: A practical guide. Breast J 2020; 26:1556-1564. [PMID: 32662170 DOI: 10.1111/tbj.13967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 11/28/2022]
Abstract
Breast cancer risk assessment continues to evolve as emerging knowledge of breast cancer risk drivers and modifiers enables better identification of high-risk women who may benefit from increased screening or targeted risk-reduction protocols. The ongoing development of breast cancer Risk Assessment and Management Programs (RAMPs) presents an opportunity to decrease breast cancer disease incidence with evidence-based interventions. The goal of this review was to provide a practical guide for providers seeking to establish or update a breast cancer risk assessment and management program. We outline genetic/familial, personal, reproductive, and lifestyle-related factors while discussing the incorporation of risk modeling for precise risk estimate personalization. We further describe the process for determining a risk management plan: information gathering, generation of a risk profile, and articulation and implementation of risk reduction. We also include an overview of clinical workflows in breast cancer management programs and underlines the logistics of establishing a program as well as general principles for guiding the formulation of an individualized risk management plan. We discuss practical considerations, such as clinic structure and operation, allocation of resources, and patient education. Other critical aspects of program design, including identification of the target population, delineation of the core components of the clinical experience, definition of provider roles, description of referral mechanisms, and the launching of a marketing plan are also addressed. The process of risk assessment is both anxiety-provoking and empowering for women at increased risk. New knowledge has enabled strategies to both understand the risk and control it through evidence-based risk management. These benefits can now be realized by an increasing number of unaffected, high-risk patients collaborating with risk management practitioners. Continuation of these efforts will lead to further progress in both risk stratification and risk management of women at elevated breast cancer risk in the near future.
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Affiliation(s)
- Theresa Sciaraffa
- Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Barbara Guido
- Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Seema A Khan
- Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Swati Kulkarni
- Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois, USA
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9
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Zeng Z, Vo A, Li X, Shidfar A, Saldana P, Blanco L, Xuei X, Luo Y, Khan SA, Clare SE. Somatic genetic aberrations in benign breast disease and the risk of subsequent breast cancer. NPJ Breast Cancer 2020; 6:24. [PMID: 32566745 PMCID: PMC7293275 DOI: 10.1038/s41523-020-0165-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/08/2020] [Indexed: 01/05/2023] Open
Abstract
It is largely unknown how the development of breast cancer (BC) is transduced by somatic genetic alterations in the benign breast. Since benign breast disease is an established risk factor for BC, we established a case-control study of women with a history of benign breast biopsy (BBB). Cases developed BC at least one year after BBB and controls did not develop BC over an average of 17 years following BBB. 135 cases were matched to 69 controls by age and type of benign change: non-proliferative or proliferation without atypia (PDWA). Whole-exome sequencing (WES) was performed for the BBB. Germline DNA (available from n = 26 participants) was utilized to develop a mutation-calling pipeline, to allow differentiation of somatic from germline variants. Among the 204 subjects, two known mutational signatures were identified, along with a currently uncatalogued signature that was significantly associated with triple negative BC (TNBC) (p = 0.007). The uncatalogued mutational signature was validated in 109 TNBCs from TCGA (p = 0.001). Compared to non-proliferative samples, PDWA harbors more abundant mutations at PIK3CA pH1047R (p < 0.001). Among the 26 BBB whose somatic copy number variation could be assessed, deletion of MLH3 is significantly associated with the mismatch repair mutational signature (p < 0.001). Matched BBB-cancer pairs were available for ten cases; several mutations were shared between BBB and cancers. This initial study of WES of BBB shows its potential for the identification of genetic alterations that portend breast oncogenesis. In future larger studies, robust personalized breast cancer risk indicators leading to novel interception paradigms can be assessed.
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Affiliation(s)
- Zexian Zeng
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Department of Data Sciences, Dana-Farber Cancer Institute, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Andy Vo
- Committee on Developmental Biology and Regenerative Medicine, The University of Chicago, Chicago, IL USA
| | - Xiaoyu Li
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
| | - Ali Shidfar
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Paulette Saldana
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Luis Blanco
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Xiaoling Xuei
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN USA
| | - Yuan Luo
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Seema A. Khan
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Susan E. Clare
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL USA
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10
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Kashyap D, Kaur H. Cell-free miRNAs as non-invasive biomarkers in breast cancer: Significance in early diagnosis and metastasis prediction. Life Sci 2020; 246:117417. [PMID: 32044304 DOI: 10.1016/j.lfs.2020.117417] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/28/2020] [Accepted: 02/05/2020] [Indexed: 02/07/2023]
Abstract
Breast cancer is one of the genetic diseases causing a high mortality among women around the world. Despite the availability of advanced diagnostic tools and treatment strategies, the incidence of breast cancer is increasing every year. This is due to the lack of accurate and reliable biomarkers whose deficiency creates difficulty in early breast cancer recognition, subtypes determination, and metastasis prophecy. Although biomarkers such as ER, PR, Her2, Ki-67, and other genetic platforms e.g. MammaPrint®, Oncotype DX®, Prosigna® or EndoPredict® are available for determination of breast cancer diagnosis and prognosis. However, pertaining to heterogeneous nature, lack of sensitivity, and specificity of these markers, it is still incessant to overcome breast cancer burden. Therefore, a novel biomarker is urgently needed for therapeutic diagnosis and improving prognosis. Lately, it has become more evident that cell-free miRNAs might be useful as good non-invasive biomarkers that are associated with different events in carcinogenesis. For example, some known biomarkers such as miR-21, miR-23a, miR-34a are associated with molecular subtyping and different biomolecular aspects i.e. apoptosis, angiogenesis, metastasis, and miR-1, miR-10b, miR-16 are associated with drug response. Cell-free miRNAs present in human body fluids have proven to be potential biomarkers with significant prognostic and predictive values. Numerous studies have found a distinct expression profile of circulating miRNAs in breast tumour versus non-tumour and in early and advanced-stage, thus implicating its clinical relevance. This review article will highlight the importance of different cell-free miRNAs as a biomarker for early breast cancer detection, subtype classification, and metastasis forecast.
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Affiliation(s)
- Dharambir Kashyap
- Department of Histopathology, Postgraduation Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Harmandeep Kaur
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
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11
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A decade of FRAX: how has it changed the management of osteoporosis? Aging Clin Exp Res 2020; 32:187-196. [PMID: 32043227 DOI: 10.1007/s40520-019-01432-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/21/2019] [Indexed: 01/14/2023]
Abstract
The fracture risk assessment tool, FRAX®, was released in 2008 and provides country-specific algorithms for estimating individualized 10-year probability of hip and major osteoporotic fracture (hip, clinical spine, distal forearm, and proximal humerus). Since its release, 71 models have been made available for 66 countries covering more than 80% of the world population. The website receives approximately 3 million visits annually. Following independent validation, FRAX has been incorporated into more than 80 guidelines worldwide. The application of FRAX in assessment guidelines has been heterogeneous with the adoption of several different approaches in setting intervention thresholds. Whereas most guidelines adopt a case-finding strategy, the case for FRAX-based community screening in the elderly is increasing. The relationship between FRAX and efficacy of intervention has been explored and is expected to influence treatment guidelines in the future.
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12
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Stark GF, Hart GR, Nartowt BJ, Deng J. Predicting breast cancer risk using personal health data and machine learning models. PLoS One 2019; 14:e0226765. [PMID: 31881042 PMCID: PMC6934281 DOI: 10.1371/journal.pone.0226765] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/03/2019] [Indexed: 12/23/2022] Open
Abstract
Among women, breast cancer is a leading cause of death. Breast cancer risk predictions can inform screening and preventative actions. Previous works found that adding inputs to the widely-used Gail model improved its ability to predict breast cancer risk. However, these models used simple statistical architectures and the additional inputs were derived from costly and / or invasive procedures. By contrast, we developed machine learning models that used highly accessible personal health data to predict five-year breast cancer risk. We created machine learning models using only the Gail model inputs and models using both Gail model inputs and additional personal health data relevant to breast cancer risk. For both sets of inputs, six machine learning models were trained and evaluated on the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial data set. The area under the receiver operating characteristic curve metric quantified each model’s performance. Since this data set has a small percentage of positive breast cancer cases, we also reported sensitivity, specificity, and precision. We used Delong tests (p < 0.05) to compare the testing data set performance of each machine learning model to that of the Breast Cancer Risk Prediction Tool (BCRAT), an implementation of the Gail model. None of the machine learning models with only BCRAT inputs were significantly stronger than the BCRAT. However, the logistic regression, linear discriminant analysis, and neural network models with the broader set of inputs were all significantly stronger than the BCRAT. These results suggest that relative to the BCRAT, additional easy-to-obtain personal health inputs can improve five-year breast cancer risk prediction. Our models could be used as non-invasive and cost-effective risk stratification tools to increase early breast cancer detection and prevention, motivating both immediate actions like screening and long-term preventative measures such as hormone replacement therapy and chemoprevention.
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Affiliation(s)
- Gigi F. Stark
- Department of Therapeutic Radiology, Yale University, New Haven, CT, United States of America
| | - Gregory R. Hart
- Department of Therapeutic Radiology, Yale University, New Haven, CT, United States of America
| | - Bradley J. Nartowt
- Department of Therapeutic Radiology, Yale University, New Haven, CT, United States of America
| | - Jun Deng
- Department of Therapeutic Radiology, Yale University, New Haven, CT, United States of America
- * E-mail:
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13
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Zhang Z, Bien J, Mori M, Jindal S, Bergan R. A way forward for cancer prevention therapy: personalized risk assessment. Oncotarget 2019; 10:6898-6912. [PMID: 31839883 PMCID: PMC6901339 DOI: 10.18632/oncotarget.27365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022] Open
Abstract
Cancer is characterized by genetic and molecular aberrations whose number and complexity increase dramatically as cells progress along the spectrum of carcinogenesis. The pharmacologic application of agents in the context of a lower burden of dysregulated cellular processes constitutes an efficient strategy to enhance therapeutic efficacy, and underlies the rationale for using cancer prevention agents in high-risk populations. A longstanding barrier to implementing this strategy is that the risk in the general population is low for any given cancer, many people would have to be treated in order to benefit a few. Therefore, identifying and treating high-risk individuals will improve the risk: benefit ratio. Currently, risk is defined by considering a relatively low number of factors. A strategy that considers multiple factors has the ability to define a much-higher-risk cohort than the general population. This article will review the rationale for evaluating multiple risk factors so as to identify individuals at highest risk. It will use breast and lung cancer as examples, will describe currently available risk assessment tools, and will discuss ongoing efforts to expand the impact of this approach. The high potential of this strategy to provide a way forward for developing cancer prevention therapy will be highlighted.
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Affiliation(s)
- Zhenzhen Zhang
- Division of Hematology/Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jeffrey Bien
- Division of Oncology, Stanford University, Palo Alto, California, USA
| | - Motomi Mori
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA.,OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Sonali Jindal
- Department of Cell, Developmental & Cancer Biology, Oregon Health & Science University, Portland, Oregon, USA
| | - Raymond Bergan
- Division of Hematology/Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
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14
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Owens DK, Davidson KW, Krist AH, Barry MJ, Cabana M, Caughey AB, Doubeni CA, Epling JW, Kubik M, Landefeld CS, Mangione CM, Pbert L, Silverstein M, Tseng CW, Wong JB. Medication Use to Reduce Risk of Breast Cancer: US Preventive Services Task Force Recommendation Statement. JAMA 2019; 322:857-867. [PMID: 31479144 DOI: 10.1001/jama.2019.11885] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Breast cancer is the most common nonskin cancer among women in the United States and the second leading cause of cancer death. The median age at diagnosis is 62 years, and an estimated 1 in 8 women will develop breast cancer at some point in their lifetime. African American women are more likely to die of breast cancer compared with women of other races. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on medications for risk reduction of primary breast cancer. EVIDENCE REVIEW The USPSTF reviewed evidence on the accuracy of risk assessment methods to identify women who could benefit from risk-reducing medications for breast cancer, as well as evidence on the effectiveness, adverse effects, and subgroup variations of these medications. The USPSTF reviewed evidence from randomized trials, observational studies, and diagnostic accuracy studies of risk stratification models in women without preexisting breast cancer or ductal carcinoma in situ. FINDINGS The USPSTF found convincing evidence that risk assessment tools can predict the number of cases of breast cancer expected to develop in a population. However, these risk assessment tools perform modestly at best in discriminating between individual women who will or will not develop breast cancer. The USPSTF found convincing evidence that risk-reducing medications (tamoxifen, raloxifene, or aromatase inhibitors) provide at least a moderate benefit in reducing risk for invasive estrogen receptor-positive breast cancer in postmenopausal women at increased risk for breast cancer. The USPSTF found that the benefits of taking tamoxifen, raloxifene, and aromatase inhibitors to reduce risk for breast cancer are no greater than small in women not at increased risk for the disease. The USPSTF found convincing evidence that tamoxifen and raloxifene and adequate evidence that aromatase inhibitors are associated with small to moderate harms. Overall, the USPSTF determined that the net benefit of taking medications to reduce risk of breast cancer is larger in women who have a greater risk for developing breast cancer. CONCLUSIONS AND RECOMMENDATION The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects. (B recommendation) The USPSTF recommends against the routine use of risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, in women who are not at increased risk for breast cancer. (D recommendation) This recommendation applies to asymptomatic women 35 years and older, including women with previous benign breast lesions on biopsy (such as atypical ductal or lobular hyperplasia and lobular carcinoma in situ). This recommendation does not apply to women who have a current or previous diagnosis of breast cancer or ductal carcinoma in situ.
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Affiliation(s)
| | - Douglas K Owens
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Stanford University, Stanford, California
| | - Karina W Davidson
- Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York
| | - Alex H Krist
- Fairfax Family Practice Residency, Fairfax, Virginia
- Virginia Commonwealth University, Richmond
| | | | | | | | | | | | | | | | | | - Lori Pbert
- University of Massachusetts Medical School, Worcester
| | | | - Chien-Wen Tseng
- University of Hawaii, Honolulu
- Pacific Health Research and Education Institute, Honolulu, Hawaii
| | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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15
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Nelson HD, Fu R, Zakher B, Pappas M, McDonagh M. Medication Use for the Risk Reduction of Primary Breast Cancer in Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2019; 322:868-886. [PMID: 31479143 DOI: 10.1001/jama.2019.5780] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Medications to reduce risk of breast cancer are effective for women at increased risk but also cause adverse effects. OBJECTIVE To update the 2013 US Preventive Services Task Force systematic review on medications to reduce risk of primary (first diagnosis) invasive breast cancer in women. DATA SOURCES Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, EMBASE, and MEDLINE (January 1, 2013, to February 1, 2019); manual review of reference lists. STUDY SELECTION Discriminatory accuracy studies of breast cancer risk assessment methods; randomized clinical trials of tamoxifen, raloxifene, and aromatase inhibitors for primary breast cancer prevention; studies of medication adverse effects. DATA EXTRACTION AND SYNTHESIS Investigators abstracted data on methods, participant characteristics, eligibility criteria, outcome ascertainment, and follow-up. Results of individual trials were combined by using a profile likelihood random-effects model. MAIN OUTCOMES AND MEASURES Probability of breast cancer in individuals (area under the receiver operating characteristic curve [AUC]); incidence of breast cancer, fractures, thromboembolic events, coronary heart disease events, stroke, endometrial cancer, and cataracts; and mortality. RESULTS A total of 46 studies (82 articles [>5 million participants]) were included. Eighteen risk assessment methods in 25 studies reported low accuracy in predicting the probability of breast cancer in individuals (AUC, 0.55-0.65). In placebo-controlled trials, tamoxifen (risk ratio [RR], 0.69 [95% CI, 0.59-0.84]; 4 trials [n = 28 421]), raloxifene (RR, 0.44 [95% CI, 0.24-0.80]; 2 trials [n = 17 806]), and the aromatase inhibitors exemestane and anastrozole (RR, 0.45 [95% CI, 0.26-0.70]; 2 trials [n = 8424]) were associated with a lower incidence of invasive breast cancer. Risk for invasive breast cancer was higher for raloxifene than tamoxifen in 1 trial after long-term follow-up (RR, 1.24 [95% CI, 1.05-1.47]; n = 19 747). Raloxifene was associated with lower risk for vertebral fractures (RR, 0.61 [95% CI, 0.53-0.73]; 2 trials [n = 16 929]) and tamoxifen was associated with lower risk for nonvertebral fractures (RR, 0.66 [95% CI, 0.45-0.98]; 1 trial [n = 13 388]) compared with placebo. Tamoxifen and raloxifene were associated with increased thromboembolic events compared with placebo; tamoxifen was associated with more events than raloxifene. Tamoxifen was associated with higher risk of endometrial cancer and cataracts compared with placebo. Symptomatic effects (eg, vasomotor, musculoskeletal) varied by medication. CONCLUSIONS AND RELEVANCE Tamoxifen, raloxifene, and aromatase inhibitors were associated with lower risk of primary invasive breast cancer in women but also were associated with adverse effects that differed between medications. Risk stratification methods to identify patients with increased breast cancer risk demonstrated low accuracy.
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Affiliation(s)
- Heidi D Nelson
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
- School of Public Health, Oregon Health & Science University, Portland
| | - Bernadette Zakher
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
- School of Public Health, Oregon Health & Science University, Portland
| | - Miranda Pappas
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
| | - Marian McDonagh
- Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland
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16
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World Cancer Research Fund International: Continuous Update Project-systematic literature review and meta-analysis of observational cohort studies on physical activity, sedentary behavior, adiposity, and weight change and breast cancer risk. Cancer Causes Control 2019; 30:1183-1200. [PMID: 31471762 DOI: 10.1007/s10552-019-01223-w] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 08/16/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of the present study was to systematically review the complex associations between energy balance-related factors and breast cancer risk, for which previous evidence has suggested different associations in the life course of women and by hormone receptor (HR) status of the tumor. METHODS Relevant publications on adulthood physical activity, sedentary behavior, body mass index (BMI), waist and hip circumferences, waist-to-hip ratio, and weight change and pre- and postmenopausal breast cancer risk were identified in PubMed up to 30 April 2017. Random-effects meta-analyses were conducted to summarize the relative risks across studies. RESULTS One hundred and twenty-six observational cohort studies comprising over 22,900 premenopausal and 103,000 postmenopausal breast cancer cases were meta-analyzed. Higher physical activity was inversely associated with both pre- and postmenopausal breast cancers, whereas increased sitting time was positively associated with postmenopausal breast cancer. Although higher early adult BMI (ages 18-30 years) was inversely associated with pre- and postmenopausal breast cancers, adult weight gain and greater body adiposity increased breast cancer risk in postmenopausal women, and the increased risk was evident for HR+ but not HR- breast cancers, and among never but not current users of postmenopausal hormones. The evidence was less consistent in premenopausal women. There were no associations with adult weight gain, inverse associations with adult BMI (study baseline) and hip circumference, and non-significant associations with waist circumference and waist-to-hip ratio that were reverted to positive associations on average in studies accounting for BMI. No significant associations were observed for HR-defined premenopausal breast cancers. CONCLUSION Better understanding on the impact of these factors on pre- and postmenopausal breast cancers and their subtypes along the life course is needed.
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17
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Clendenen TV, Ge W, Koenig KL, Afanasyeva Y, Agnoli C, Brinton LA, Darvishian F, Dorgan JF, Eliassen AH, Falk RT, Hallmans G, Hankinson SE, Hoffman-Bolton J, Key TJ, Krogh V, Nichols HB, Sandler DP, Schoemaker MJ, Sluss PM, Sund M, Swerdlow AJ, Visvanathan K, Zeleniuch-Jacquotte A, Liu M. Breast cancer risk prediction in women aged 35-50 years: impact of including sex hormone concentrations in the Gail model. Breast Cancer Res 2019; 21:42. [PMID: 30890167 PMCID: PMC6425605 DOI: 10.1186/s13058-019-1126-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/05/2019] [Indexed: 12/28/2022] Open
Abstract
Background Models that accurately predict risk of breast cancer are needed to help younger women make decisions about when to begin screening. Premenopausal concentrations of circulating anti-Müllerian hormone (AMH), a biomarker of ovarian reserve, and testosterone have been positively associated with breast cancer risk in prospective studies. We assessed whether adding AMH and/or testosterone to the Gail model improves its prediction performance for women aged 35–50. Methods In a nested case-control study including ten prospective cohorts (1762 invasive cases/1890 matched controls) with pre-diagnostic serum/plasma samples, we estimated relative risks (RR) for the biomarkers and Gail risk factors using conditional logistic regression and random-effects meta-analysis. Absolute risk models were developed using these RR estimates, attributable risk fractions calculated using the distributions of the risk factors in the cases from the consortium, and population-based incidence and mortality rates. The area under the receiver operating characteristic curve (AUC) was used to compare the discriminatory accuracy of the models with and without biomarkers. Results The AUC for invasive breast cancer including only the Gail risk factor variables was 55.3 (95% CI 53.4, 57.1). The AUC increased moderately with the addition of AMH (AUC 57.6, 95% CI 55.7, 59.5), testosterone (AUC 56.2, 95% CI 54.4, 58.1), or both (AUC 58.1, 95% CI 56.2, 59.9). The largest AUC improvement (4.0) was among women without a family history of breast cancer. Conclusions AMH and testosterone moderately increase the discriminatory accuracy of the Gail model among women aged 35–50. We observed the largest AUC increase for women without a family history of breast cancer, the group that would benefit most from improved risk prediction because early screening is already recommended for women with a family history. Electronic supplementary material The online version of this article (10.1186/s13058-019-1126-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tess V Clendenen
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA
| | - Wenzhen Ge
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA
| | - Karen L Koenig
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA
| | - Yelena Afanasyeva
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Farbod Darvishian
- Department of Pathology, New York University School of Medicine, New York, NY, USA.,Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Göran Hallmans
- Department of Biobank Research, Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Susan E Hankinson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Judith Hoffman-Bolton
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.,Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | - Patrick M Sluss
- Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Malin Sund
- Department of Surgery, Umeå University Hospital, Umeå, Sweden
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Sidney Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA.,Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - Mengling Liu
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA. .,Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA.
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18
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Nickson C, Procopio P, Velentzis LS, Carr S, Devereux L, Mann GB, James P, Lee G, Wellard C, Campbell I. Prospective validation of the NCI Breast Cancer Risk Assessment Tool (Gail Model) on 40,000 Australian women. Breast Cancer Res 2018; 20:155. [PMID: 30572910 PMCID: PMC6302513 DOI: 10.1186/s13058-018-1084-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/25/2018] [Indexed: 01/24/2023] Open
Abstract
Background There is a growing interest in delivering more personalised, risk-based breast cancer screening protocols. This requires population-level validation of practical models that can stratify women into breast cancer risk groups. Few studies have evaluated the Gail model (NCI Breast Cancer Risk Assessment Tool) in a population screening setting; we validated this tool in a large, screened population. Methods We used data from 40,158 women aged 50–69 years (via the lifepool cohort) participating in Australia’s BreastScreen programme. We investigated the association between Gail scores and future invasive breast cancer, comparing observed and expected outcomes by Gail score ranked groups. We also used machine learning to rank Gail model input variables by importance and then assessed the incremental benefit in risk prediction obtained by adding variables in order of diminishing importance. Results Over a median of 4.3 years, the Gail model predicted 612 invasive breast cancers compared with 564 observed cancers (expected/observed (E/O) = 1.09, 95% confidence interval (CI) 1.00–1.18). There was good agreement across decile groups of Gail scores (χ2 = 7.1, p = 0.6) although there was some overestimation of cancer risk in the top decile of our study group (E/O = 1.65, 95% CI 1.33–2.07). Women in the highest quintile (Q5) of Gail scores had a 2.28-fold increased risk of breast cancer (95% CI 1.73–3.02, p < 0.0001) compared with the lowest quintile (Q1). Compared with the median quintile, women in Q5 had a 34% increased risk (95% CI 1.06–1.70, p = 0.014) and those in Q1 had a 41% reduced risk (95% CI 0.44–0.79, p < 0.0001). Similar patterns were observed separately for women aged 50–59 and 60–69 years. The model’s overall discrimination was modest (area under the curve (AUC) 0.59, 95% CI 0.56–0.61). A reduced Gail model excluding information on ethnicity and hyperplasia was comparable to the full Gail model in terms of correctly stratifying women into risk groups. Conclusions This study confirms that the Gail model (or a reduced model excluding information on hyperplasia and ethnicity) can effectively stratify a screened population aged 50–69 years according to the risk of future invasive breast cancer. This information has the potential to enable more personalised, risk-based screening strategies that aim to improve the balance of the benefits and harms of screening. Electronic supplementary material The online version of this article (10.1186/s13058-018-1084-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carolyn Nickson
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, 3010, Australia. .,Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, 2011, Australia.
| | - Pietro Procopio
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, 3010, Australia.,Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, 2011, Australia
| | - Louiza S Velentzis
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, 3010, Australia.,Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW, 2011, Australia
| | - Sarah Carr
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, 3010, Australia
| | - Lisa Devereux
- Lifepool Study, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia
| | - Gregory Bruce Mann
- Breast Service, Royal Women's and Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia.,Department of Surgery, The University of Melbourne, Parkville, 3010, Australia
| | - Paul James
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, 3000, Australia.,Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, Victoria, 3052, Australia
| | - Grant Lee
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, 3010, Australia
| | - Cameron Wellard
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, 3010, Australia
| | - Ian Campbell
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, 3000, Australia.,Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, 3000, Australia
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Li K, Anderson G, Viallon V, Arveux P, Kvaskoff M, Fournier A, Krogh V, Tumino R, Sánchez MJ, Ardanaz E, Chirlaque MD, Agudo A, Muller DC, Smith T, Tzoulaki I, Key TJ, Bueno-de-Mesquita B, Trichopoulou A, Bamia C, Orfanos P, Kaaks R, Hüsing A, Fortner RT, Zeleniuch-Jacquotte A, Sund M, Dahm CC, Overvad K, Aune D, Weiderpass E, Romieu I, Riboli E, Gunter MJ, Dossus L, Prentice R, Ferrari P. Risk prediction for estrogen receptor-specific breast cancers in two large prospective cohorts. Breast Cancer Res 2018; 20:147. [PMID: 30509329 PMCID: PMC6276150 DOI: 10.1186/s13058-018-1073-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 11/04/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Few published breast cancer (BC) risk prediction models consider the heterogeneity of predictor variables between estrogen-receptor positive (ER+) and negative (ER-) tumors. Using data from two large cohorts, we examined whether modeling this heterogeneity could improve prediction. METHODS We built two models, for ER+ (ModelER+) and ER- tumors (ModelER-), respectively, in 281,330 women (51% postmenopausal at recruitment) from the European Prospective Investigation into Cancer and Nutrition cohort. Discrimination (C-statistic) and calibration (the agreement between predicted and observed tumor risks) were assessed both internally and externally in 82,319 postmenopausal women from the Women's Health Initiative study. We performed decision curve analysis to compare ModelER+ and the Gail model (ModelGail) regarding their applicability in risk assessment for chemoprevention. RESULTS Parity, number of full-term pregnancies, age at first full-term pregnancy and body height were only associated with ER+ tumors. Menopausal status, age at menarche and at menopause, hormone replacement therapy, postmenopausal body mass index, and alcohol intake were homogeneously associated with ER+ and ER- tumors. Internal validation yielded a C-statistic of 0.64 for ModelER+ and 0.59 for ModelER-. External validation reduced the C-statistic of ModelER+ (0.59) and ModelGail (0.57). In external evaluation of calibration, ModelER+ outperformed the ModelGail: the former led to a 9% overestimation of the risk of ER+ tumors, while the latter yielded a 22% underestimation of the overall BC risk. Compared with the treat-all strategy, ModelER+ produced equal or higher net benefits irrespective of the benefit-to-harm ratio of chemoprevention, while ModelGail did not produce higher net benefits unless the benefit-to-harm ratio was below 50. The clinical applicability, i.e. the area defined by the net benefit curve and the treat-all and treat-none strategies, was 12.7 × 10- 6 for ModelER+ and 3.0 × 10- 6 for ModelGail. CONCLUSIONS Modeling heterogeneous epidemiological risk factors might yield little improvement in BC risk prediction. Nevertheless, a model specifically predictive of ER+ tumor risk could be more applicable than an omnibus model in risk assessment for chemoprevention.
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Affiliation(s)
- Kuanrong Li
- Nutritional Methodology and Biostatistics Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Garnet Anderson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Vivian Viallon
- Nutritional Methodology and Biostatistics Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Patrick Arveux
- Breast and Gynaecologic Cancer Registry of Côte d’Or, Georges-François Leclerc Comprehensive Cancer Care Centre, Dijon, France
- EA 4184, Medical School, University of Burgundy, Dijon, France
- CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Marina Kvaskoff
- CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Agnès Fournier
- CESP, INSERM U1018, Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, “Civic-M. P.Arezzo” Hospital, ASP, Ragusa, Italy
| | - Maria-Jose Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs. GRANADA, Hospitales Universitarios de Granada/ Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Eva Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - María-Dolores Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Antonio Agudo
- Unit of Nutrition and Cancer. Cancer Epidemiology Research Program, Catalan Institute of Oncology-IDIBELL. L’Hospitalet de Llobregat, Barcelona, Spain
| | - David C. Muller
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Todd Smith
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Ioanna Tzoulaki
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Timothy J. Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bas Bueno-de-Mesquita
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Bamia
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Philippos Orfanos
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Anika Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Renée T. Fortner
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health, New York University School of Medicine, New York, USA
- Department of Environmental Medicine, New York University School of Medicine, New York, USA
- Perlmutter Cancer Center, New York University School of Medicine, New York, USA
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Christina C. Dahm
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Dagfinn Aune
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
| | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
- Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Isabelle Romieu
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Elio Riboli
- Department of Epidemiology & Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Marc J. Gunter
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Laure Dossus
- Biomarkers Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Ross Prentice
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Pietro Ferrari
- Nutritional Methodology and Biostatistics Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
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20
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Al-Ajmi K, Lophatananon A, Yuille M, Ollier W, Muir KR. Review of non-clinical risk models to aid prevention of breast cancer. Cancer Causes Control 2018; 29:967-986. [PMID: 30178398 PMCID: PMC6182451 DOI: 10.1007/s10552-018-1072-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 08/10/2018] [Indexed: 12/29/2022]
Abstract
A disease risk model is a statistical method which assesses the probability that an individual will develop one or more diseases within a stated period of time. Such models take into account the presence or absence of specific epidemiological risk factors associated with the disease and thereby potentially identify individuals at higher risk. Such models are currently used clinically to identify people at higher risk, including identifying women who are at increased risk of developing breast cancer. Many genetic and non-genetic breast cancer risk models have been developed previously. We have evaluated existing non-genetic/non-clinical models for breast cancer that incorporate modifiable risk factors. This review focuses on risk models that can be used by women themselves in the community in the absence of clinical risk factors characterization. The inclusion of modifiable factors in these models means that they can be used to improve primary prevention and health education pertinent for breast cancer. Literature searches were conducted using PubMed, ScienceDirect and the Cochrane Database of Systematic Reviews. Fourteen studies were eligible for review with sample sizes ranging from 654 to 248,407 participants. All models reviewed had acceptable calibration measures, with expected/observed (E/O) ratios ranging from 0.79 to 1.17. However, discrimination measures were variable across studies with concordance statistics (C-statistics) ranging from 0.56 to 0.89. We conclude that breast cancer risk models that include modifiable risk factors have been well calibrated but have less ability to discriminate. The latter may be a consequence of the omission of some significant risk factors in the models or from applying models to studies with limited sample sizes. More importantly, external validation is missing for most of the models. Generalization across models is also problematic as some variables may not be considered applicable to some populations and each model performance is conditioned by particular population characteristics. In conclusion, it is clear that there is still a need to develop a more reliable model for estimating breast cancer risk which has a good calibration, ability to accurately discriminate high risk and with better generalizability across populations.
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Affiliation(s)
- Kawthar Al-Ajmi
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, The University of Manchester, Manchester, M139 PL UK
| | - Artitaya Lophatananon
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, The University of Manchester, Manchester, M139 PL UK
| | - Martin Yuille
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, The University of Manchester, Manchester, M139 PL UK
| | - William Ollier
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, The University of Manchester, Manchester, M139 PL UK
| | - Kenneth R. Muir
- Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Centre for Epidemiology, The University of Manchester, Manchester, M139 PL UK
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21
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Borgquist S, Hall P, Lipkus I, Garber JE. Towards Prevention of Breast Cancer: What Are the Clinical Challenges? Cancer Prev Res (Phila) 2018; 11:255-264. [PMID: 29661853 DOI: 10.1158/1940-6207.capr-16-0254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 12/28/2016] [Accepted: 02/21/2018] [Indexed: 11/16/2022]
Abstract
The dramatic increase in breast cancer incidence compels a paradigm shift in our preventive efforts. There are several barriers to overcome before prevention becomes an established part of breast cancer management. The objective of this review is to identify the clinical challenges for improved breast cancer prevention and discuss current knowledge on breast cancer risk assessment methods, risk communication, ethics, and interventional efforts with the aim of covering the aspects relevant for a breast cancer prevention trial. Herein, the following five areas are discussed: (i) Adequate tools for identification of women at high risk of breast cancer suggestively entitled Prevent! Online. (ii) Consensus on the definition of high risk, which is regarded as mandatory for all risk communication and potential prophylactic interventions. (iii) Risk perception and communication regarding risk information. (iv) Potential ethical concerns relevant for future breast cancer prevention programs. (v) Risk-reducing programs involving multileveled prevention depending on identified risk. Taken together, devoted efforts from both policy makers and health care providers are warranted to improve risk assessment and risk counseling in women at risk for breast cancer to optimize the prevention of breast cancer. Cancer Prev Res; 11(5); 255-64. ©2018 AACR.
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Affiliation(s)
- Signe Borgquist
- Lund University, Department of Oncology and Pathology, Skåne University Hospital, Lund, Sweden. .,Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Isaac Lipkus
- Duke University School of Nursing, Durham, North Carolina
| | - Judy E Garber
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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22
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Wang X, Huang Y, Li L, Dai H, Song F, Chen K. Assessment of performance of the Gail model for predicting breast cancer risk: a systematic review and meta-analysis with trial sequential analysis. Breast Cancer Res 2018; 20:18. [PMID: 29534738 PMCID: PMC5850919 DOI: 10.1186/s13058-018-0947-5] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 02/26/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Gail model has been widely used and validated with conflicting results. The current study aims to evaluate the performance of different versions of the Gail model by means of systematic review and meta-analysis with trial sequential analysis (TSA). METHODS Three systematic review and meta-analyses were conducted. Pooled expected-to-observed (E/O) ratio and pooled area under the curve (AUC) were calculated using the DerSimonian and Laird random-effects model. Pooled sensitivity, specificity and diagnostic odds ratio were evaluated by bivariate mixed-effects model. TSA was also conducted to determine whether the evidence was sufficient and conclusive. RESULTS Gail model 1 accurately predicted breast cancer risk in American women (pooled E/O = 1.03; 95% CI 0.76-1.40). The pooled E/O ratios of Caucasian-American Gail model 2 in American, European and Asian women were 0.98 (95% CI 0.91-1.06), 1.07 (95% CI 0.66-1.74) and 2.29 (95% CI 1.95-2.68), respectively. Additionally, Asian-American Gail model 2 overestimated the risk for Asian women about two times (pooled E/O = 1.82; 95% CI 1.31-2.51). TSA showed that evidence in Asian women was sufficient; nonetheless, the results in American and European women need further verification. The pooled AUCs for Gail model 1 in American and European women and Asian females were 0.55 (95% CI 0.53-0.56) and 0.75 (95% CI 0.63-0.88), respectively, and the pooled AUCs of Caucasian-American Gail model 2 for American, Asian and European females were 0.61 (95% CI 0.59-0.63), 0.55 (95% CI 0.52-0.58) and 0.58 (95% CI 0.55-0.62), respectively. The pooled sensitivity, specificity and diagnostic odds ratio of Gail model 1 were 0.63 (95% CI 0.27-0.89), 0.91 (95% CI 0.87-0.94) and 17.38 (95% CI 2.66-113.70), respectively, and the corresponding indexes of Gail model 2 were 0.35 (95% CI 0.17-0.59), 0.86 (95% CI 0.76-0.92) and 3.38 (95% CI 1.40-8.17), respectively. CONCLUSIONS The Gail model was more accurate in predicting the incidence of breast cancer in American and European females, while far less useful for individual-level risk prediction. Moreover, the Gail model may overestimate the risk in Asian women and the results were further validated by TSA, which is an addition to the three previous systematic review and meta-analyses. TRIAL REGISTRATION PROSPERO CRD42016047215 .
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Affiliation(s)
- Xin Wang
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060 People’s Republic of China
| | - Yubei Huang
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060 People’s Republic of China
| | - Lian Li
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060 People’s Republic of China
| | - Hongji Dai
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060 People’s Republic of China
| | - Fengju Song
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060 People’s Republic of China
| | - Kexin Chen
- Department of Epidemiology and Biostatistics, Key Laboratory of Cancer Prevention and Therapy, Tianjin Key Laboratory of Breast Cancer Prevention and Therapy, Ministry of Education, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Xi Road, Tiyuan Bei, Hexi District, Tianjin, 300060 People’s Republic of China
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23
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Patrício M, Pereira J, Crisóstomo J, Matafome P, Gomes M, Seiça R, Caramelo F. Using Resistin, glucose, age and BMI to predict the presence of breast cancer. BMC Cancer 2018; 18:29. [PMID: 29301500 PMCID: PMC5755302 DOI: 10.1186/s12885-017-3877-1] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/05/2017] [Indexed: 12/11/2022] Open
Abstract
Background The goal of this exploratory study was to develop and assess a prediction model which can potentially be used as a biomarker of breast cancer, based on anthropometric data and parameters which can be gathered in routine blood analysis. Methods For each of the 166 participants several clinical features were observed or measured, including age, BMI, Glucose, Insulin, HOMA, Leptin, Adiponectin, Resistin and MCP-1. Machine learning algorithms (logistic regression, random forests, support vector machines) were implemented taking in as predictors different numbers of variables. The resulting models were assessed with a Monte Carlo Cross-Validation approach to determine 95% confidence intervals for the sensitivity, specificity and AUC of the models. Results Support vector machines models using Glucose, Resistin, Age and BMI as predictors allowed predicting the presence of breast cancer in women with sensitivity ranging between 82 and 88% and specificity ranging between 85 and 90%. The 95% confidence interval for the AUC was [0.87, 0.91]. Conclusions These findings provide promising evidence that models combining age, BMI and metabolic parameters may be a powerful tool for a cheap and effective biomarker of breast cancer. Electronic supplementary material The online version of this article (10.1186/s12885-017-3877-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miguel Patrício
- Laboratory of Biostatistics and Medical Informatics and IBILI - Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548, Coimbra, Portugal.
| | - José Pereira
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Joana Crisóstomo
- Laboratory of Physiology, IBILI - Faculty of Medicine of University of Coimbra, Coimbra, Portugal
| | - Paulo Matafome
- Laboratory of Physiology, IBILI - Faculty of Medicine of University of Coimbra, Coimbra, Portugal.,Department of Complementary Sciences, Coimbra Health School - Instituto Politécnico de Coimbra, Coimbra, Portugal
| | - Manuel Gomes
- Department of Internal Medicine, University Hospital Centre of Coimbra, Coimbra, Portugal
| | - Raquel Seiça
- Laboratory of Physiology, IBILI - Faculty of Medicine of University of Coimbra, Coimbra, Portugal
| | - Francisco Caramelo
- Laboratory of Biostatistics and Medical Informatics and IBILI - Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548, Coimbra, Portugal
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24
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Genetic and environmental factors and serum hormones, and risk of estrogen receptor-positive breast cancer in pre- and postmenopausal Japanese women. Oncotarget 2017; 8:65759-65769. [PMID: 29029469 PMCID: PMC5630369 DOI: 10.18632/oncotarget.20182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/04/2017] [Indexed: 12/22/2022] Open
Abstract
Breast cancer incidence in Japanese women has more than tripled over the past two decades. We have previously shown that this marked increase is mostly due to an increase in the estrogen receptor (ER)-positive, HER2-negative subtype. We conducted a case-control study; ER-positive, HER2-negative breast cancer patients who were diagnosed since 2011 and women without disease were recruited. Environmental factors, serum levels of testosterone and 25-hydroxyvitamin D, and common genetic variants reported as predictors of ER-positive breast cancer or found in Asian women were evaluated between patients and controls in pre- and postmenopausal women. To identify important risk predictors, risk prediction models were created by logistic regression models. In premenopausal women, two environmental factors (history of breastfeeding, and history of benign breast disease) and four genetic variants (TOX3-rs3803662, ESR1-rs2046210, 8q24-rs13281615, and SLC4A7-rs4973768) were considered to be risk predictors, whereas three environmental factors (body mass index, history of breastfeeding, and hyperlipidemia), serum levels of testosterone and 25-hydroxyvitamin D, and two genetic variants (TOX3-rs3803662 and ESR1-rs2046210) were identified as risk predictors. Inclusion of common genetic variants and serum hormone measurements as well as environmental factors improved risk assessment models. The decline in the birthrate according to recent changes of lifestyle might be the main cause of the recent notable increase in the incidence of ER-positive breast cancer in Japanese women.
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25
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Bado I, Gugala Z, Fuqua SAW, Zhang XHF. Estrogen receptors in breast and bone: from virtue of remodeling to vileness of metastasis. Oncogene 2017; 36:4527-4537. [PMID: 28368409 PMCID: PMC5552443 DOI: 10.1038/onc.2017.94] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 12/11/2022]
Abstract
Bone metastasis is a prominent cause of morbidity and mortality in cancer. High rates of bone colonization in breast cancer, especially in the subtype expressing estrogen receptors (ERs), suggest tissue-specific proclivities for metastatic tumor formation. The mechanisms behind this subtype-specific organ-tropism remains largely elusive. Interestingly, as the major driver of ER+ breast cancer, ERs also have important roles in bone development and homeostasis. Thus, any agents targeting ER will also inevitably affect the microenvironment, which involves the osteoblasts and osteoclasts. Yet, how such microenvironmental effects are integrated with direct therapeutic responses of cancer cells remain poorly understood. Recent findings on ER mutations, especially their enrichment in bone metastasis, raised even more provocative questions on the role of ER in cancer-bone interaction. In this review, we evaluate the importance of ERs in bone metastasis and discuss new avenues of investigation for bone metastasis treatment based on current knowledge.
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Affiliation(s)
- Igor Bado
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030
- Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030
- Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030
| | - Zbigniew Gugala
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555
| | - Suzanne A. W. Fuqua
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030
- Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030
| | - Xiang H.-F. Zhang
- Lester and Sue Smith Breast Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030
- Dan L. Duncan Cancer Center, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030
- Department of Molecular and Cellular Biology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030
- McNair Medical Institute, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030
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26
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Abstract
The fracture risk assessment tool, FRAX, was released in 2008 and provides country-specific algorithms for estimating individualized 10-year probability of hip and major osteoporotic fracture (hip, clinical spine, distal forearm, and proximal humerus). Since its release, models are now available for 63 countries, covering 79% of the world population. The website receives approximately 3 million visits annually. Following independent validation, FRAX has been incorporated into more than 80 guidelines worldwide. However, the application of FRAX in guidelines has been heterogeneous with the adoption of several different approaches to setting intervention thresholds. The relationship between FRAX and efficacy of intervention has been explored and is expected to influence treatment guidelines in the future. A more unified approach to setting intervention thresholds with FRAX is a research priority.
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Affiliation(s)
- John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK; Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia.
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Helena Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK; Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Odén
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
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27
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Family history and risk of breast cancer: an analysis accounting for family structure. Breast Cancer Res Treat 2017; 165:193-200. [PMID: 28578505 PMCID: PMC5511313 DOI: 10.1007/s10549-017-4325-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 12/30/2022]
Abstract
Purpose Family history is an important risk factor for breast cancer incidence, but the parameters conventionally used to categorize it are based solely on numbers and/or ages of breast cancer cases in the family and take no account of the size and age-structure of the woman’s family. Methods Using data from the Generations Study, a cohort of over 113,000 women from the general UK population, we analyzed breast cancer risk in relation to first-degree family history using a family history score (FHS) that takes account of the expected number of family cases based on the family’s age-structure and national cancer incidence rates. Results Breast cancer risk increased significantly (Ptrend < 0.0001) with greater FHS. There was a 3.5-fold (95% CI 2.56–4.79) range of risk between the lowest and highest FHS groups, whereas women who had two or more relatives with breast cancer, the strongest conventional familial risk factor, had a 2.5-fold (95% CI 1.83–3.47) increase in risk. Using likelihood ratio tests, the best model for determining breast cancer risk due to family history was that combining FHS and age of relative at diagnosis. Conclusions A family history score based on expected as well as observed breast cancers in a family can give greater risk discrimination on breast cancer incidence than conventional parameters based solely on cases in affected relatives. Our modeling suggests that a yet stronger predictor of risk might be a combination of this score and age at diagnosis in relatives. Electronic supplementary material The online version of this article (doi:10.1007/s10549-017-4325-2) contains supplementary material, which is available to authorized users.
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Shieh Y, Eklund M, Madlensky L, Sawyer SD, Thompson CK, Stover Fiscalini A, Ziv E, Van't Veer LJ, Esserman LJ, Tice JA. Breast Cancer Screening in the Precision Medicine Era: Risk-Based Screening in a Population-Based Trial. J Natl Cancer Inst 2017; 109:2938659. [PMID: 28130475 DOI: 10.1093/jnci/djw290] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/13/2016] [Accepted: 10/31/2016] [Indexed: 01/14/2023] Open
Abstract
Ongoing controversy over the optimal approach to breast cancer screening has led to discordant professional society recommendations, particularly in women age 40 to 49 years. One potential solution is risk-based screening, where decisions around the starting age, stopping age, frequency, and modality of screening are based on individual risk to maximize the early detection of aggressive cancers and minimize the harms of screening through optimal resource utilization. We present a novel approach to risk-based screening that integrates clinical risk factors, breast density, a polygenic risk score representing the cumulative effects of genetic variants, and sequencing for moderate- and high-penetrance germline mutations. We demonstrate how thresholds of absolute risk estimates generated by our prediction tools can be used to stratify women into different screening strategies (biennial mammography, annual mammography, annual mammography with adjunctive magnetic resonance imaging, defer screening at this time) while informing the starting age of screening for women age 40 to 49 years. Our risk thresholds and corresponding screening strategies are based on current evidence but need to be tested in clinical trials. The Women Informed to Screen Depending On Measures of risk (WISDOM) Study, a pragmatic, preference-tolerant randomized controlled trial of annual vs personalized screening, will study our proposed approach. WISDOM will evaluate the efficacy, safety, and acceptability of risk-based screening beginning in the fall of 2016. The adaptive design of this trial allows continued refinement of our risk thresholds as the trial progresses, and we discuss areas where we anticipate emerging evidence will impact our approach.
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Affiliation(s)
- Yiwey Shieh
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Martin Eklund
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Lisa Madlensky
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Sarah D Sawyer
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Carlie K Thompson
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Allison Stover Fiscalini
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Elad Ziv
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Laura J Van't Veer
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Laura J Esserman
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
| | - Jeffrey A Tice
- Affiliations of authors: Division of General Internal Medicine, Department of Medicine (YS, EZ, JAT), Department of Surgery (SDS, CKT, ASF, LJE), Department of Radiology (LJE), and Department of Laboratory Medicine, Helen Diller Family Comprehensive Cancer Center (LJvV), University of California, San Francisco, San Francisco, CA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden (ME); Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA (LM)
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Kerlikowske K, Gard CC, Tice JA, Ziv E, Cummings SR, Miglioretti DL. Risk Factors That Increase Risk of Estrogen Receptor-Positive and -Negative Breast Cancer. J Natl Cancer Inst 2016; 109:2898140. [PMID: 28040694 DOI: 10.1093/jnci/djw276] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 09/17/2016] [Accepted: 10/19/2016] [Indexed: 12/15/2022] Open
Abstract
Background Risk factors may differentially influence development of estrogen receptor (ER)-positive vs -negative breast cancer. We examined associations with strong, prevalent risk factors by ER subtype. Methods Of 1 279 443 women age 35 to 74 years participating in the Breast Cancer Surveillance Consortium, 14 969 developed ER-positive and 3617 developed ER-negative invasive breast cancer. We calculated hazard ratios (HRs) using Cox regression and compared ER subtype hazard ratios at representative ages or by menopausal status using Wald tests. All statistical tests were two-sided. Results For women age 40 years, compared with no prior biopsy, ER-positive vs ER-negative HRs were 1.53 (95% CI = 1.30 to 1.81) vs 1.26 (95% CI = 0.90 to 1.76) for nonproliferative disease, 1.63 (95% CI = 1.23 to 2.17) vs 1.41 (95% CI = 0.78 to 2.57) for proliferative disease without atypia, and 4.47 (95% CI = 2.88 to 6.96) vs 0.20 (95% CI = 0.02 to 2.51) for proliferative disease with atypia. Benign disease proliferation risk was stronger for ER-positive than ER-negative cancer for women age 35 years (Wald P = .04), age 40 years (Wald P = .04), and age 50 years (Wald P = .06). Among pre/perimenopausal women, body mass index (BMI) had a stronger association with ER-negative than ER-positive cancer (obese II/III vs. normal weight: HR = 1.52, 95% CI = 1.19 to 1.94; vs 1.21, 95% CI = 1.08 to 1.36). Increasing BMI similarly increased ER-positive and ER-negative cancer risk among postmenopausal hormone users (Wald P = .15) and nonusers (Wald P = .08). Associations with ER subtype varied by race/ethnicity across all ages (P < .001) and by family history of breast cancer and breast density for specific ages. Conclusions Strength of risk factor associations differed by ER subtype. Separate risk models for ER subtypes may improve identification of women for targeted prevention strategies.
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Affiliation(s)
- Karla Kerlikowske
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
| | - Charlotte C Gard
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
| | - Jeffrey A Tice
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
| | - Elad Ziv
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
| | - Steven R Cummings
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
| | - Diana L Miglioretti
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
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Schonberg MA, Li VW, Eliassen AH, Davis RB, LaCroix AZ, McCarthy EP, Rosner BA, Chlebowski RT, Hankinson SE, Marcantonio ER, Ngo LH. Accounting for individualized competing mortality risks in estimating postmenopausal breast cancer risk. Breast Cancer Res Treat 2016; 160:547-562. [PMID: 27770283 PMCID: PMC5093031 DOI: 10.1007/s10549-016-4020-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 10/13/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Accurate risk assessment is necessary for decision-making around breast cancer prevention. We aimed to develop a breast cancer prediction model for postmenopausal women that would take into account their individualized competing risk of non-breast cancer death. METHODS We included 73,066 women who completed the 2004 Nurses' Health Study (NHS) questionnaire (all ≥57 years) and followed participants until May 2014. We considered 17 breast cancer risk factors (health behaviors, demographics, family history, reproductive factors) and 7 risk factors for non-breast cancer death (comorbidities, functional dependency) and mammography use. We used competing risk regression to identify factors independently associated with breast cancer. We validated the final model by examining calibration (expected-to-observed ratio of breast cancer incidence, E/O) and discrimination (c-statistic) using 74,887 subjects from the Women's Health Initiative Extension Study (WHI-ES; all were ≥55 years and followed for 5 years). RESULTS Within 5 years, 1.8 % of NHS participants were diagnosed with breast cancer (vs. 2.0 % in WHI-ES, p = 0.02), and 6.6 % experienced non-breast cancer death (vs. 5.2 % in WHI-ES, p < 0.001). Using a model selection procedure which incorporated the Akaike Information Criterion, c-statistic, statistical significance, and clinical judgement, our final model included 9 breast cancer risk factors, 5 comorbidities, functional dependency, and mammography use. The model's c-statistic was 0.61 (95 % CI [0.60-0.63]) in NHS and 0.57 (0.55-0.58) in WHI-ES. On average, our model under predicted breast cancer in WHI-ES (E/O 0.92 [0.88-0.97]). CONCLUSIONS We developed a novel prediction model that factors in postmenopausal women's individualized competing risks of non-breast cancer death when estimating breast cancer risk.
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Affiliation(s)
- Mara A Schonberg
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Beth Israel Deaconess Medical Center, 1309 Beacon, Office 219, Brookline, MA, 02446, USA.
| | - Vicky W Li
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roger B Davis
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Andrea Z LaCroix
- Division of Epidemiology, Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Ellen P McCarthy
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Bernard A Rosner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Susan E Hankinson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Biostatistics and Epidemiology, University of Massachusetts, 713 North Pleasant Street, Amherst, MA, USA
| | - Edward R Marcantonio
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Long H Ngo
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Relationship of Predicted Risk of Developing Invasive Breast Cancer, as Assessed with Three Models, and Breast Cancer Mortality among Breast Cancer Patients. PLoS One 2016; 11:e0160966. [PMID: 27560501 PMCID: PMC4999085 DOI: 10.1371/journal.pone.0160966] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/27/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Breast cancer risk prediction models are used to plan clinical trials and counsel women; however, relationships of predicted risks of breast cancer incidence and prognosis after breast cancer diagnosis are unknown. METHODS Using largely pre-diagnostic information from the Breast Cancer Surveillance Consortium (BCSC) for 37,939 invasive breast cancers (1996-2007), we estimated 5-year breast cancer risk (<1%; 1-1.66%; ≥1.67%) with three models: BCSC 1-year risk model (BCSC-1; adapted to 5-year predictions); Breast Cancer Risk Assessment Tool (BCRAT); and BCSC 5-year risk model (BCSC-5). Breast cancer-specific mortality post-diagnosis (range: 1-13 years; median: 5.4-5.6 years) was related to predicted risk of developing breast cancer using unadjusted Cox proportional hazards models, and in age-stratified (35-44; 45-54; 55-69; 70-89 years) models adjusted for continuous age, BCSC registry, calendar period, income, mode of presentation, stage and treatment. Mean age at diagnosis was 60 years. RESULTS Of 6,021 deaths, 2,993 (49.7%) were ascribed to breast cancer. In unadjusted case-only analyses, predicted breast cancer risk ≥1.67% versus <1.0% was associated with lower risk of breast cancer death; BCSC-1: hazard ratio (HR) = 0.82 (95% CI = 0.75-0.90); BCRAT: HR = 0.72 (95% CI = 0.65-0.81) and BCSC-5: HR = 0.84 (95% CI = 0.75-0.94). Age-stratified, adjusted models showed similar, although mostly non-significant HRs. Among women ages 55-69 years, HRs approximated 1.0. Generally, higher predicted risk was inversely related to percentages of cancers with unfavorable prognostic characteristics, especially among women 35-44 years. CONCLUSIONS Among cases assessed with three models, higher predicted risk of developing breast cancer was not associated with greater risk of breast cancer death; thus, these models would have limited utility in planning studies to evaluate breast cancer mortality reduction strategies. Further, when offering women counseling, it may be useful to note that high predicted risk of developing breast cancer does not imply that if cancer develops it will behave aggressively.
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Schonberg MA, Li VW, Eliassen AH, Davis RB, LaCroix AZ, McCarthy EP, Rosner BA, Chlebowski RT, Rohan TE, Hankinson SE, Marcantonio ER, Ngo LH. Performance of the Breast Cancer Risk Assessment Tool Among Women Age 75 Years and Older. J Natl Cancer Inst 2016; 108:djv348. [PMID: 26625899 PMCID: PMC5072372 DOI: 10.1093/jnci/djv348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/17/2015] [Accepted: 10/20/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Breast Cancer Risk Assessment Tool (BCRAT, "Gail model") is commonly used for breast cancer prediction; however, it has not been validated for women age 75 years and older. METHODS We used Nurses' Health Study (NHS) data beginning in 2004 and Women's Health Initiative (WHI) data beginning in 2005 to compare BCRAT's performance among women age 75 years and older with that in women age 55 to 74 years in predicting five-year breast cancer incidence. BCRAT risk factors include: age, race/ethnicity, age at menarche, age at first birth, family history, history of benign breast biopsy, and atypia. We examined BCRAT's calibration by age by comparing expected/observed (E/O) ratios of breast cancer incidence. We examined discrimination by computing c-statistics for the model by age. All statistical tests were two-sided. RESULTS Seventy-three thousand seventy-two NHS and 97 081 WHI women participated. NHS participants were more likely to be non-Hispanic white (96.2% vs 84.7% in WHI, P < .001) and were less likely to develop breast cancer (1.8% vs 2.0%, P = .02). E/O ratios by age in NHS were 1.16 (95% confidence interval [CI] = 1.09 to 1.23, age 57-74 years) and 1.31 (95% CI = 1.18 to 1.45, age ≥ 75 years, P = .02), and in WHI 1.03 (95% CI = 0.97 to 1.09, age 55-74 years) and 1.10 (95% CI = 1.00 to 1.21, age ≥ 75 years, P = .21). E/O ratio 95% confidence intervals crossed one among women age 75 years and older when samples were limited to women who underwent mammography and were without significant illness. C-statistics ranged between 0.56 and 0.58 in both cohorts regardless of age. CONCLUSIONS BCRAT accurately predicted breast cancer for women age 75 years and older who underwent mammography and were without significant illness but had modest discrimination. Models that consider individual competing risks of non-breast cancer death may improve breast cancer risk prediction for older women.
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Affiliation(s)
- Mara A Schonberg
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
| | - Vicky W Li
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
| | - A Heather Eliassen
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
| | - Roger B Davis
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
| | - Andrea Z LaCroix
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
| | - Ellen P McCarthy
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
| | - Bernard A Rosner
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
| | - Rowan T Chlebowski
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
| | - Thomas E Rohan
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
| | - Susan E Hankinson
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
| | - Edward R Marcantonio
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
| | - Long H Ngo
- Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH)
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Islami F, Liu Y, Jemal A, Zhou J, Weiderpass E, Colditz G, Boffetta P, Weiss M. Breastfeeding and breast cancer risk by receptor status--a systematic review and meta-analysis. Ann Oncol 2015; 26:2398-407. [PMID: 26504151 DOI: 10.1093/annonc/mdv379] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/06/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Breastfeeding is inversely associated with overall risk of breast cancer. This association may differ in breast cancer subtypes defined by receptor status, as they may reflect different mechanisms of carcinogenesis. We conducted a systematic review and meta-analysis of case-control and prospective cohort studies to investigate the association between breastfeeding and breast cancer by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status. DESIGN We searched the PubMed and Scopus databases and bibliographies of pertinent articles to identify relevant articles and used random-effects models to calculate summary odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS This meta-analysis represents 27 distinct studies (8 cohort and 19 case-control), with a total of 36 881 breast cancer cases. Among parous women, the risk estimates for the association between ever (versus never) breastfeeding and the breast cancers negative for both ER and PR were similar in three cohort and three case-control studies when results were adjusted for several factors, including the number of full-term pregnancies (combined OR 0.90; 95% CI 0.82-0.99), with little heterogeneity and no indication of publication bias. In a subset of three adjusted studies that included ER, PR, and HER2 status, ever breastfeeding showed a stronger inverse association with triple-negative breast cancer (OR 0.78; 95% CI 0.66-0.91) among parous women. Overall, cohort studies showed no significant association between breastfeeding and ER+/PR+ or ER+ and/or PR+ breast cancers, although one and two studies (out of four and seven studies, respectively) showed an inverse association. CONCLUSIONS This meta-analysis showed a protective effect of ever breastfeeding against hormone receptor-negative breast cancers, which are more common in younger women and generally have a poorer prognosis than other subtypes of breast cancer. The association between breastfeeding and receptor-positive breast cancers needs more investigation.
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Affiliation(s)
- F Islami
- Surveillance and Health Services Research, American Cancer Society, Atlanta Institute for Translational Epidemiology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York
| | - Y Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, USA
| | - A Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta
| | - J Zhou
- Institute for Translational Epidemiology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York
| | - E Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø Cancer Registry of Norway, Oslo, Norway Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
| | - G Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, USA Siteman Cancer Center, Washington University School of Medicine, St Louis
| | - P Boffetta
- Institute for Translational Epidemiology and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York
| | - M Weiss
- Breastcancer.org/breasthealth.org, Lankenau Medical Center, Wynnewood, USA
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Romieu I, Scoccianti C, Chajès V, de Batlle J, Biessy C, Dossus L, Baglietto L, Clavel-Chapelon F, Overvad K, Olsen A, Tjønneland A, Kaaks R, Lukanova A, Boeing H, Trichopoulou A, Lagiou P, Trichopoulos D, Palli D, Sieri S, Tumino R, Vineis P, Panico S, Bueno-de-Mesquita HBA, van Gils CH, Peeters PH, Lund E, Skeie G, Weiderpass E, Quirós García JR, Chirlaque MD, Ardanaz E, Sánchez MJ, Duell EJ, Amiano P, Borgquist S, Wirfält E, Hallmans G, Johansson I, Nilsson LM, Khaw KT, Wareham N, Key TJ, Travis RC, Murphy N, Wark PA, Ferrari P, Riboli E. Alcohol intake and breast cancer in the European prospective investigation into cancer and nutrition. Int J Cancer 2015; 137:1921-30. [PMID: 25677034 PMCID: PMC6300114 DOI: 10.1002/ijc.29469] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/03/2014] [Indexed: 01/12/2023]
Abstract
Alcohol intake has been associated to breast cancer in pre and postmenopausal women; however results are inconclusive regarding tumor hormonal receptor status, and potential modifying factors like age at start drinking. Therefore, we investigated the relation between alcohol intake and the risk of breast cancer using prospective observational data from the European Prospective Investigation into Cancer and Nutrition (EPIC). Up to 334,850 women, aged 35-70 years at baseline, were recruited in ten European countries and followed up an average of 11 years. Alcohol intake at baseline and average lifetime alcohol intake were calculated from country-specific dietary and lifestyle questionnaires. The study outcomes were the Hazard ratios (HR) of developing breast cancer according to hormonal receptor status. During 3,670,439 person-years, 11,576 incident breast cancer cases were diagnosed. Alcohol intake was significantly related to breast cancer risk, for each 10 g/day increase in alcohol intake the HR increased by 4.2% (95% CI: 2.7-5.8%). Taking 0 to 5 g/day as reference, alcohol intake of >5 to 15 g/day was related to a 5.9% increase in breast cancer risk (95% CI: 1-11%). Significant increasing trends were observed between alcohol intake and ER+/PR+, ER-/PR-, HER2- and ER-/PR-HER2- tumors. Breast cancer risk was stronger among women who started drinking prior to first full-time pregnancy. Overall, our results confirm the association between alcohol intake and both hormone receptor positive and hormone receptor negative breast tumors, suggesting that timing of exposure to alcohol drinking may affect the risk. Therefore, women should be advised to control their alcohol consumption.
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Affiliation(s)
- Isabelle Romieu
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Chiara Scoccianti
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Véronique Chajès
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Jordi de Batlle
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Carine Biessy
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Laure Dossus
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France
- University Paris Sud, UMRS 1018, Villejuif, France
- Institut Gustave-Roussy, Villejuif, France
| | - Laura Baglietto
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Françoise Clavel-Chapelon
- Inserm, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health Team, Villejuif, France
- University Paris Sud, UMRS 1018, Villejuif, France
- Institut Gustave-Roussy, Villejuif, France
| | - Kim Overvad
- Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark
| | - Anja Olsen
- Diet, Genes, and Environment Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Tjønneland
- Diet, Genes, and Environment Unit, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Nuthetal, Germany
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
| | - Pagona Lagiou
- WHO Collaborating Center for Food and Nutrition Policies, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Dimitrios Trichopoulos
- Hellenic Health Foundation, Athens, Greece
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Department of Epidemiology, Harvard School of Public Health, Boston, MA
| | - Domenico Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - Sabina Sieri
- Epidemiology and Prevention Unit, Department of Preventive & Predictive Medicine, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civic-M.P.Arezzo" Hospital, ASP Ragusa, Italy
| | - Paolo Vineis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Unit of molecular and genetic epidemiology, Human Genetics Foundation (HuGeF), Turin, Italy
| | - Salvatore Panico
- Department of Clinical and Experimental Medicine Federico II University of Naples, Naples, Italy
| | - H B As Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology University Medical Centre, Utrecht, The Netherlands
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra H Peeters
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eiliv Lund
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
- Department of Genetic Epidemiology, Folkhälsan Research Center, Helsinki, Finland
- Etiological Research Unit, Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | | | - María-Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
| | - Eva Ardanaz
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - María-José Sánchez
- CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain
- Andalusian School of Public Health, Granada Bio-Health Research Institute (Granada.IBS), Granada, Spain
- Instituto De Investigación Biosanitaria De Granada, Granada, Spain
| | - Eric J Duell
- Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Pilar Amiano
- Public Health Division of Gipuzkoa, Gipuzkoa, Spain
| | - Signe Borgquist
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Göran Hallmans
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | | | - Lena Maria Nilsson
- Public Health and Clinical Medicine/Nutritional Research, Umeå University, Umeå, Sweden
| | - Kay-Tee Khaw
- University of Cambridge, School of Clinical Medicine, Clinical Gerontology Unit, Cambridge, United Kingdom
| | - Nick Wareham
- MRC Epidemiology Unit University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Neil Murphy
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Petra A Wark
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Pietro Ferrari
- Nutritional Epidemiology Group, Nutrition and Metabolism Section, International Agency for Research on Cancer, Lyon, France
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
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Fusar-Poli P, Cappucciati M, Rutigliano G, Schultze-Lutter F, Bonoldi I, Borgwardt S, Riecher-Rössler A, Addington J, Perkins D, Woods SW, McGlashan TH, Lee J, Klosterkötter J, Yung AR, McGuire P. At risk or not at risk? A meta-analysis of the prognostic accuracy of psychometric interviews for psychosis prediction. World Psychiatry 2015; 14:322-32. [PMID: 26407788 PMCID: PMC4592655 DOI: 10.1002/wps.20250] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
An accurate detection of individuals at clinical high risk (CHR) for psychosis is a prerequisite for effective preventive interventions. Several psychometric interviews are available, but their prognostic accuracy is unknown. We conducted a prognostic accuracy meta-analysis of psychometric interviews used to examine referrals to high risk services. The index test was an established CHR psychometric instrument used to identify subjects with and without CHR (CHR+ and CHR-). The reference index was psychosis onset over time in both CHR+ and CHR- subjects. Data were analyzed with MIDAS (STATA13). Area under the curve (AUC), summary receiver operating characteristic curves, quality assessment, likelihood ratios, Fagan's nomogram and probability modified plots were computed. Eleven independent studies were included, with a total of 2,519 help-seeking, predominately adult subjects (CHR+: N=1,359; CHR-: N=1,160) referred to high risk services. The mean follow-up duration was 38 months. The AUC was excellent (0.90; 95% CI: 0.87-0.93), and comparable to other tests in preventive medicine, suggesting clinical utility in subjects referred to high risk services. Meta-regression analyses revealed an effect for exposure to antipsychotics and no effects for type of instrument, age, gender, follow-up time, sample size, quality assessment, proportion of CHR+ subjects in the total sample. Fagan's nomogram indicated a low positive predictive value (5.74%) in the general non-help-seeking population. Albeit the clear need to further improve prediction of psychosis, these findings support the use of psychometric prognostic interviews for CHR as clinical tools for an indicated prevention in subjects seeking help at high risk services worldwide.
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Affiliation(s)
- Paolo Fusar-Poli
- King's College London, Institute of Psychiatry, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ilaria Bonoldi
- King's College London, Institute of Psychiatry, London, UK
| | | | | | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Diana Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | | | - Jimmy Lee
- Department of General Psychiatry, Institute of Mental Health, Singapore, Singapore
| | | | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Philip McGuire
- King's College London, Institute of Psychiatry, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
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36
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Dartois L, Gauthier É, Heitzmann J, Baglietto L, Michiels S, Mesrine S, Boutron-Ruault MC, Delaloge S, Ragusa S, Clavel-Chapelon F, Fagherazzi G. A comparison between different prediction models for invasive breast cancer occurrence in the French E3N cohort. Breast Cancer Res Treat 2015; 150:415-26. [PMID: 25744293 DOI: 10.1007/s10549-015-3321-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/23/2015] [Indexed: 02/07/2023]
Abstract
Breast cancer remains a global health concern with a lack of high discriminating prediction models. The k-nearest-neighbor algorithm (kNN) estimates individual risks using an intuitive tool. This study compares the performances of this approach with the Cox and the Gail models for the 5-year breast cancer risk prediction. The study included 64,995 women from the French E3N prospective cohort. The sample was divided into a learning (N = 51,821) series to learn the models using fivefold cross-validation and a validation (N = 13,174) series to evaluate them. The area under the receiver operating characteristic curve (AUC) and the expected over observed number of cases (E/O) ratio were estimated. In the two series, 393 and 78 premenopausal and 537 and 98 postmenopausal breast cancers were diagnosed. The discrimination values of the best combinations of predictors obtained from cross-validation ranged from 0.59 to 0.60. In the validation series, the AUC values in premenopausal and postmenopausal women were 0.583 [0.520; 0.646] and 0.621 [0.563; 0.679] using the kNN and 0.565 [0.500; 0.631] and 0.617 [0.561; 0.673] using the Cox model. The E/O ratios were 1.26 and 1.28 in premenopausal women and 1.44 and 1.40 in postmenopausal women. The applied Gail model provided AUC values of 0.614 [0.554; 0.675] and 0.549 [0.495; 0.604] and E/O ratios of 0.78 and 1.12. This study shows that the prediction performances differed according to menopausal status when using parametric statistical tools. The k-nearest-neighbor approach performed well, and discrimination was improved in postmenopausal women compared with the Gail model.
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Affiliation(s)
- Laureen Dartois
- Inserm (Institut National de la Santé et de la Recherche Médicale), Centre for Research in Epidemiology and Population Health (CESP), U1018, Team 9, 114 rue Édouard Vaillant, 94805, Villejuif Cedex, France
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Development of a risk assessment tool for projecting individualized probabilities of developing breast cancer for Chinese women. Tumour Biol 2014; 35:10861-9. [PMID: 25085581 DOI: 10.1007/s13277-014-1967-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/11/2014] [Indexed: 01/13/2023] Open
Abstract
The optimal approach regarding breast cancer screening for Chinese women is unclear due to the relative low incidence rate. A risk assessment tool may be useful for selection of high-risk subsets of population for mammography screening in low-incidence and resource-limited developing country. The odd ratios for six main risk factors of breast cancer were pooled by review manager after a systematic research of literature. Health risk appraisal (HRA) model was developed to predict an individual's risk of developing breast cancer in the next 5 years from current age. The performance of this HRA model was assessed based on a first-round screening database. Estimated risk of breast cancer increased with age. Increases in the 5-year risk of developing breast cancer were found with the existence of any of included risk factors. When individuals who had risk above median risk (3.3‰) were selected from the validation database, the sensitivity is 60.0% and the specificity is 47.8%. The unweighted area under the curve (AUC) was 0.64 (95% CI = 0.50-0.78). The risk-prediction model reported in this article is based on a combination of risk factors and shows good overall predictive power, but it is still weak at predicting which particular women will develop the disease. It would be very helpful for the improvement of a current model if more population-based prospective follow-up studies were used for the validation.
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Association between oestrogens receptor expressions in breast cancer and comorbidities: a cross-sectional, population-based study. PLoS One 2014; 9:e98127. [PMID: 24848085 PMCID: PMC4029934 DOI: 10.1371/journal.pone.0098127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 04/28/2014] [Indexed: 12/25/2022] Open
Abstract
Background Breast cancer with oestrogen receptor expression is common in older women. Several factors, such as age and reproductive hormone exposure, have been associated with oestrogen receptor expression in breast cancer. However, the association between comorbidities and the oestrogen receptor expression has been poorly studied. We hypothesized that there was an association between burden comorbidity and breast cancer with oestrogen receptor expression in older women. Objective To determine whether oestrogen receptor expression in breast cancer was associated with burden comorbidity in community-dwelling women. Methods A total of 1,707 women with breast cancer registered on the list of a breast cancer registry were included. The recorded data included: age, Charlson Comorbidity Index score≥1, breast cancer characteristics (coded according to the International Classification of Diseases for Oncology), and breast cancer pathological stage (the pathological-tumour-node-metastasis, Scarff Bloom Richardson, and hormonal status of oestrogen receptor, progesterone receptor, and human epidermal growth factor receptor). Results Breast cancer with oestrogen receptor expression was identified in 1,378 patients (80·7%). The fully-adjusted logistic regression showed that oestrogen receptor expression was associated with Charlson Comorbidity Index score≥1 (odds ratio [OR] = 1·91,95%confidence interval [CI] = [1.01–3.61], P = 0·048), progesterone receptor expression (OR = 16·64, 95%CI = [11.62–23.81], P<0·001), human epidermal growth factor receptor (OR = 0·54, 95%CI = [0.34–0.84], P = 0·007), age (OR = 1.02, 95%CI = [1.00–1.03], P = 0.008), Scarff Bloom Richardson grade II and grade III (OR = 0·21with 95%CI = [0.10–0.44] and OR = 0·06 with 95%CI = [0.03–0.12], P<0·001). Conclusion Our findings provide new data showing an independent positive association between burden comorbidity and breast cancer with oestrogen receptor expression. This result confirms that evaluation of oestrogen receptor expression in breast cancer should not be limited to hormonal factors stratified by age.
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Brinton LA, Smith L, Gierach GL, Pfeiffer RM, Nyante SJ, Sherman ME, Park Y, Hollenbeck AR, Dallal CM. Breast cancer risk in older women: results from the NIH-AARP Diet and Health Study. Cancer Causes Control 2014; 25:843-57. [PMID: 24810653 DOI: 10.1007/s10552-014-0385-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/09/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Divergent risk factors exist for premenopausal and postmenopausal breast cancers, but it is unclear whether differences by age exist among postmenopausal women. METHODS We examined relationships among 190,872 postmenopausal women, ages 50-71 years recruited during 1995-1996 for the NIH-AARP Diet and Health Study, in whom 7,384 incident invasive breast carcinomas were identified through 2006. Multivariable Cox regression hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for breast cancer risk factors by age (50-59, 60-69, ≥70 years). RESULTS The only factor showing significant statistical heterogeneity by age (p(het) = 0.001) was menopausal hormone therapy duration, but trends were apparent across all ages and the strongest association prevailed among women 60-69 years. Although other risk factors did not show statistically significant heterogeneity by age, we did observe attenuated relations for parity and late age at first birth among older women [e.g., HR for age at first birth ≥30 vs. 20-24 = 1.62 (95% CI 1.23-2.14) for women 50-59 years vs. 1.12 (0.96-1.31) for ≥70 years]. In contrast, risk estimates associated with alcohol consumption and BMI tended to be slightly stronger among the oldest subjects [e.g., HR for BMI ≥35 vs. 18.5-24.9 = 1.24 (95% CI 0.97-1.58) for 50-59 years vs. 1.46 (1.26-1.70) for ≥70 years]. These differences were somewhat more pronounced for estrogen receptor positive and ductal cancers, tumors predominating among older women. Breast cancer family history, physical activity, and previous breast biopsies did not show divergent associations by age. CONCLUSION Although breast cancer risk factor differences among older women were not large, they may merit further consideration with respect to individualized risk prediction.
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Affiliation(s)
- Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, USA,
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Purrington KS, Slager S, Eccles D, Yannoukakos D, Fasching PA, Miron P, Carpenter J, Chang-Claude J, Martin NG, Montgomery GW, Kristensen V, Anton-Culver H, Goodfellow P, Tapper WJ, Rafiq S, Gerty SM, Durcan L, Konstantopoulou I, Fostira F, Vratimos A, Apostolou P, Konstanta I, Kotoula V, Lakis S, Dimopoulos MA, Skarlos D, Pectasides D, Fountzilas G, Beckmann MW, Hein A, Ruebner M, Ekici AB, Hartmann A, Schulz-Wendtland R, Renner SP, Janni W, Rack B, Scholz C, Neugebauer J, Andergassen U, Lux MP, Haeberle L, Clarke C, Pathmanathan N, Rudolph A, Flesch-Janys D, Nickels S, Olson JE, Ingle JN, Olswold C, Slettedahl S, Eckel-Passow JE, Anderson S, Visscher DW, Cafourek VL, Sicotte H, Prodduturi N, Weiderpass E, Bernstein L, Ziogas A, Ivanovich J, Giles GG, Baglietto L, Southey M, Kosma VM, Fischer HP, Reed MW, Cross SS, Deming-Halverson S, Shrubsole M, Cai Q, Shu XO, Daly M, Weaver J, Ross E, Klemp J, Sharma P, Torres D, Rüdiger T, Wölfing H, Ulmer HU, Försti A, Khoury T, Kumar S, Pilarski R, Shapiro CL, Greco D, Heikkilä P, Aittomäki K, Blomqvist C, Irwanto A, Liu J, Pankratz VS, Wang X, Severi G, Mannermaa A, Easton D, Hall P, Brauch H, Cox A, Zheng W, Godwin AK, Hamann U, Ambrosone C, Toland AE, Nevanlinna H, Vachon CM, Couch FJ. Genome-wide association study identifies 25 known breast cancer susceptibility loci as risk factors for triple-negative breast cancer. Carcinogenesis 2014; 35:1012-9. [PMID: 24325915 PMCID: PMC4004200 DOI: 10.1093/carcin/bgt404] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 11/04/2013] [Accepted: 11/27/2013] [Indexed: 11/14/2022] Open
Abstract
Triple-negative (TN) breast cancer is an aggressive subtype of breast cancer associated with a unique set of epidemiologic and genetic risk factors. We conducted a two-stage genome-wide association study of TN breast cancer (stage 1: 1529 TN cases, 3399 controls; stage 2: 2148 cases, 1309 controls) to identify loci that influence TN breast cancer risk. Variants in the 19p13.1 and PTHLH loci showed genome-wide significant associations (P < 5 × 10(-) (8)) in stage 1 and 2 combined. Results also suggested a substantial enrichment of significantly associated variants among the single nucleotide polymorphisms (SNPs) analyzed in stage 2. Variants from 25 of 74 known breast cancer susceptibility loci were also associated with risk of TN breast cancer (P < 0.05). Associations with TN breast cancer were confirmed for 10 loci (LGR6, MDM4, CASP8, 2q35, 2p24.1, TERT-rs10069690, ESR1, TOX3, 19p13.1, RALY), and we identified associations with TN breast cancer for 15 additional breast cancer loci (P < 0.05: PEX14, 2q24.1, 2q31.1, ADAM29, EBF1, TCF7L2, 11q13.1, 11q24.3, 12p13.1, PTHLH, NTN4, 12q24, BRCA2, RAD51L1-rs2588809, MKL1). Further, two SNPs independent of previously reported signals in ESR1 [rs12525163 odds ratio (OR) = 1.15, P = 4.9 × 10(-) (4)] and 19p13.1 (rs1864112 OR = 0.84, P = 1.8 × 10(-) (9)) were associated with TN breast cancer. A polygenic risk score (PRS) for TN breast cancer based on known breast cancer risk variants showed a 4-fold difference in risk between the highest and lowest PRS quintiles (OR = 4.03, 95% confidence interval 3.46-4.70, P = 4.8 × 10(-) (69)). This translates to an absolute risk for TN breast cancer ranging from 0.8% to 3.4%, suggesting that genetic variation may be used for TN breast cancer risk prediction.
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Affiliation(s)
| | - Susan Slager
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Diana Eccles
- Faculty of Medicine, University of Southampton SO17 1BJ, Southampton, UK
| | - Drakoulis Yannoukakos
- Molecular Diagnostics Laboratory INRASTES, National Centre for Scientific Research “Demokritos”, Athens 153 10, Greece
| | - Peter A. Fasching
- Department of Medicine, Division of Hematology/Oncology, University of California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen; Friedrich-Alexander University Erlangen-Nuremberg, Erlangen D-91012, Germany
| | - Penelope Miron
- Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Jane Carpenter
- Australian Breast Cancer Tissue Bank, University of Sydney at the Westmead Millennium Institute, Westmead, New South Wales, NSW 2145 Australia
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Nicholas G. Martin
- QIMR GWAS Collective, Queensland Institute of Medical Research, Brisbane, Queensland, QLD 4006 Australia
| | - Grant W. Montgomery
- QIMR GWAS Collective, Queensland Institute of Medical Research, Brisbane, Queensland, QLD 4006 Australia
| | - Vessela Kristensen
- Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Radiumhospitalet, Oslo 0316, Norway
- Faculty of Medicine (Faculty Division Ahus), Universitetet i Oslo, Oslo 0316, Norway
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California–Irvine, Irvine, CA 92697, USA
| | - Paul Goodfellow
- Washington University School of Medicine, Barnes-Jewish Hospital and Siteman Cancer Center, St Louis, MO 63110, USA
| | - William J. Tapper
- Faculty of Medicine, University of Southampton SO17 1BJ, Southampton, UK
| | - Sajjad Rafiq
- Faculty of Medicine, University of Southampton SO17 1BJ, Southampton, UK
| | - Susan M. Gerty
- Faculty of Medicine, University of Southampton SO17 1BJ, Southampton, UK
| | - Lorraine Durcan
- Faculty of Medicine, University of Southampton SO17 1BJ, Southampton, UK
| | - Irene Konstantopoulou
- Molecular Diagnostics Laboratory INRASTES, National Centre for Scientific Research “Demokritos”, Athens 153 10, Greece
| | - Florentia Fostira
- Molecular Diagnostics Laboratory INRASTES, National Centre for Scientific Research “Demokritos”, Athens 153 10, Greece
| | - Athanassios Vratimos
- Molecular Diagnostics Laboratory INRASTES, National Centre for Scientific Research “Demokritos”, Athens 153 10, Greece
| | - Paraskevi Apostolou
- Molecular Diagnostics Laboratory INRASTES, National Centre for Scientific Research “Demokritos”, Athens 153 10, Greece
| | - Irene Konstanta
- Molecular Diagnostics Laboratory INRASTES, National Centre for Scientific Research “Demokritos”, Athens 153 10, Greece
| | | | - Sotiris Lakis
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research, Aristotle University of Thessaloniki School of Medicine, Thessaloniki 54124, Greece
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens School of Medicine, Athens 115 27, Greece
| | - Dimosthenis Skarlos
- Second Department of Medical Oncology, “Metropolitan” Hospital, Athens 151 25, Greece
| | - Dimitrios Pectasides
- Second Department of Internal Medicine, Oncology Section, “Hippokration” Hospital, University of Athens School of Medicine, Athens 115 27, Greece
| | - George Fountzilas
- Department of Medical Oncology, “Papageorgiou” Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki 54124, Greece
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen; Friedrich-Alexander University Erlangen-Nuremberg, Erlangen D-91012, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen; Friedrich-Alexander University Erlangen-Nuremberg, Erlangen D-91012, Germany
| | - Matthias Ruebner
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen; Friedrich-Alexander University Erlangen-Nuremberg, Erlangen D-91012, Germany
| | | | | | - Ruediger Schulz-Wendtland
- Institute of Diagnostic Radiology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen D-91012, Germany
| | - Stefan P. Renner
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen; Friedrich-Alexander University Erlangen-Nuremberg, Erlangen D-91012, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm 89069, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ludwig Maximilians University, Campus Innenstadt, Munich 80539, Germany
| | - Christoph Scholz
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm 89069, Germany
| | - Julia Neugebauer
- Department of Gynecology and Obstetrics, University Hospital Ludwig Maximilians University, Campus Innenstadt, Munich 80539, Germany
| | - Ulrich Andergassen
- Department of Gynecology and Obstetrics, University Hospital Ludwig Maximilians University, Campus Innenstadt, Munich 80539, Germany
| | - Michael P. Lux
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen; Friedrich-Alexander University Erlangen-Nuremberg, Erlangen D-91012, Germany
| | - Lothar Haeberle
- Department of Gynecology and Obstetrics, University Breast Center Franconia, University Hospital Erlangen; Friedrich-Alexander University Erlangen-Nuremberg, Erlangen D-91012, Germany
| | - Christine Clarke
- Westmead Institute for Cancer Research, Sydney Medical School Westmead, University of Sydney at the Westmead Millennium Institute, Westmead, New South Wales NSW 2145, Australia
| | - Nirmala Pathmanathan
- Westmead Breast Cancer Institute, Westmead Hospital, Westmead, New South Wales NSW 2145, Australia
| | - Anja Rudolph
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Dieter Flesch-Janys
- Institute for Medical Biometrics and Epidemiology, University Clinic Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Stefan Nickels
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Janet E. Olson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Curtis Olswold
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Seth Slettedahl
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | | | - S.Keith Anderson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel W. Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Hugues Sicotte
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Naresh Prodduturi
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Elisabete Weiderpass
- Department of Community Medicine, University of Tromsø, Tromsø 9019, Norway
- Folkhälsan Research Cancer Centre, Helsinki 00250, Finland
- Cancer Registry of Norway, Oslo N-0304, Norway
| | - Leslie Bernstein
- Department of Population Sciences, Division of Cancer Etiology, Beckman Research Institute, City of Hope, Duarte 91010, USA
| | - Argyrios Ziogas
- Department of Epidemiology, University of California–Irvine, Irvine, CA 92697, USA
| | - Jennifer Ivanovich
- Washington University School of Medicine, Barnes-Jewish Hospital and Siteman Cancer Center, St Louis, MO 63110, USA
| | - Graham G. Giles
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Victoria VIC 3053, Australia
| | - Laura Baglietto
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Victoria VIC 3053, Australia
| | - Melissa Southey
- Department of Pathology, The University of Melbourne, Melbourne, Victoria VIC 3053, Australia
| | - Veli-Matti Kosma
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine; Biocenter Kuopio, Cancer Center of Eastern Finland, and Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, University of Eastern Finland, Kuopio 80130, Finland
| | - Hans-Peter Fischer
- Department of Pathology, Medical Faculty University Bonn, Bonn 53127, Germany
| | - The GENICA Network
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tuebingen 72074, Germany, 72074
- Department of Internal Medicine, Evangelische Kliniken Bonn gGmbH, Johanniter Krankenhaus, Bonn 53127, Germany
- Institute for Occupational Medicine and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg 20246, Germany
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum D-44789, Germany
- Institute of Pathology, Medical Faculty of the University of Bonn, Bonn 53127, Germany
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Malcom W.R. Reed
- Department of Oncology, Cancer Research UK/Yorkshire Cancer Research Sheffield Cancer Research Centre and
| | - Simon S. Cross
- Department of Neuroscience, University of Sheffield, Sheffield S10 2TN, UK
| | - Sandra Deming-Halverson
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Martha Shrubsole
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Qiuyin Cai
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Xiao-Ou Shu
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Mary Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, PA 19111-2497, USA
| | - JoEllen Weaver
- PennMed Biobank, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Eric Ross
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA 19111-2497, USA
| | - Jennifer Klemp
- Department of Oncology/Hematology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Priyanka Sharma
- Department of Oncology/Hematology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Diana Torres
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
- Institute of Human Genetics, Pontificia University Javeriana, Bogota D.C. 11001000, Colombia
| | - Thomas Rüdiger
- Institute of Pathology, Städtisches Klinikum Karlsruhe, Karlsruhe 76133, Germany
| | - Heidrun Wölfing
- Institute of Pathology, Städtisches Klinikum Karlsruhe, Karlsruhe 76133, Germany
| | - Hans-Ulrich Ulmer
- Frauenklinik der Stadtklinik Baden-Baden, Baden-Baden 76530, Germany
| | - Asta Försti
- Center for Primary Health Care Research, University of Lund, Malmö 223 63, Sweden
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | | | - Shicha Kumar
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | - Robert Pilarski
- Department of Internal Medicine, Division of Human Genetics and
| | - Charles L. Shapiro
- Department of Internal Medicine, Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | | | | | | | - Carl Blomqvist
- Department of Oncology, Helsinki University Central Hospital, Helsinki 00014, Finland
| | - Astrid Irwanto
- Human Genetics Division, Genome Institute of Singapore, Singapore 138672 Singapore
| | - Jianjun Liu
- Human Genetics Division, Genome Institute of Singapore, Singapore 138672 Singapore
| | | | - Xianshu Wang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Gianluca Severi
- Cancer Epidemiology Centre, The Cancer Council Victoria, Melbourne, Victoria VIC 3053, Australia
| | - Arto Mannermaa
- School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine; Biocenter Kuopio, Cancer Center of Eastern Finland, and Imaging Center, Department of Clinical Pathology, Kuopio University Hospital, University of Eastern Finland, Kuopio 80130, Finland
| | - Douglas Easton
- Department of Public Health and Primary Care, Department of Oncology, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge CB2 1TN, UK
| | - Per Hall
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Hiltrud Brauch
- Dr Margarete Fischer-Bosch-Institute of Clinical Pharmacology, Stuttgart and University of Tuebingen, Tuebingen 72074, Germany, 72074
| | - Angela Cox
- Department of Oncology, Cancer Research UK/Yorkshire Cancer Research Sheffield Cancer Research Centre and
| | - Wei Zheng
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Andrew K. Godwin
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Ute Hamann
- Molecular Genetics of Breast Cancer, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Christine Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
| | - Amanda Ewart Toland
- Departments of Internal Medicine and Molecular Virology, Immunology and Medical Genetics, Division of Human Cancer Genetics, Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210, USA
| | | | - Celine M. Vachon
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
| | - Fergus J. Couch
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
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O'Neill SC, Leventhal KG, Scarles M, Evans CN, Makariou E, Pien E, Willey S. Mammographic breast density as a risk factor for breast cancer: awareness in a recently screened clinical sample. Womens Health Issues 2014; 24:e321-6. [PMID: 24725756 DOI: 10.1016/j.whi.2014.02.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast density is an established, independent risk factor for breast cancer. Despite this, density has not been included in standard risk models or routinely disclosed to patients. However, this is changing in the face of legal mandates and advocacy efforts. Little information exists regarding women's awareness of density as a risk factor, their personal risk, and risk management options. METHODS We assessed awareness of density as a risk factor and whether sociodemographic variables, breast cancer risk factors. and perceived breast cancer risk were associated with awareness in 344 women with a recent screening mammogram at a tertiary care center. FINDINGS Overall, 62% of women had heard about density as a risk factor and 33% had spoken to a provider about breast density. Of the sample, 18% reported that their provider indicated that they had high breast density. Awareness of density as a risk factor was greater among White women and those with other breast cancer risk factors. CONCLUSION Our results suggest that although a growing number of women are aware of breast density as a risk factor, this awareness varies. Growing mandates for disclosure suggest the need for patient education interventions for women at increased risk for the disease and to ensure all women are equally aware of their risks.
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Affiliation(s)
- Suzanne C O'Neill
- Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
| | - Kara Grace Leventhal
- Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Marie Scarles
- Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Chalanda N Evans
- Department of Oncology, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Erini Makariou
- Department of Radiology, Georgetown University Hospital, Washington, DC
| | - Edward Pien
- Department of Radiology, Georgetown University Hospital, Washington, DC
| | - Shawna Willey
- Department of Surgery, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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Scoccianti C, Lauby-Secretan B, Bello PY, Chajes V, Romieu I. Female breast cancer and alcohol consumption: a review of the literature. Am J Prev Med 2014; 46:S16-25. [PMID: 24512927 DOI: 10.1016/j.amepre.2013.10.031] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 10/29/2013] [Accepted: 10/29/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT Consumption of alcoholic beverages is one of the single most important known and modifiable risk factor for human cancer. Among women, breast cancer is the most common cancer worldwide and the leading cause of cancer-related mortality. Consumption of alcoholic beverages is causally associated with female breast cancer and the association shows a linear dose-response relationship. The role of heavy drinking has been long recognized and even a moderate intake is associated with an increased risk for breast cancer. The present review is an update of the current evidence on the association between alcohol consumption and breast cancer risk. The aim is to gain further insight into this association and to improve our current understanding of the effects of the major modifying factors. EVIDENCE ACQUISITION Epidemiologic and experimental studies published since the most recent International Agency for Research on Cancer (IARC) Monograph on alcoholic beverages were identified in PubMed using a combination of keywords such as alcohol, breast cancer, polymorphisms, menopausal status. EVIDENCE SYNTHESIS Cumulative lifetime consumption, drinking frequency, drinking patterns and timing of exposure each modulate the association between alcohol consumption and breast cancer. Hormonal status, genetic polymorphisms, and nutritional factors may interact with ethanol metabolism and further influence breast cancer risk. CONCLUSIONS Better standardization among experimental and epidemiologic designs in assessing alcohol intake and timing of exposure may improve our understanding of the heterogeneity observed across studies, possibly allowing the quantification of the effects of occasional heavy drinking and the identification of a window of higher susceptibility to breast cancer development.
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Affiliation(s)
- Chiara Scoccianti
- Nutritional Epidemiology Group, International Agency for Research on Cancer, Lyon
| | | | | | - Véronique Chajes
- Nutritional Epidemiology Group, International Agency for Research on Cancer, Lyon
| | - Isabelle Romieu
- Nutritional Epidemiology Group, International Agency for Research on Cancer, Lyon.
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Munsell MF, Sprague BL, Berry DA, Chisholm G, Trentham-Dietz A. Body mass index and breast cancer risk according to postmenopausal estrogen-progestin use and hormone receptor status. Epidemiol Rev 2014; 36:114-36. [PMID: 24375928 PMCID: PMC3873844 DOI: 10.1093/epirev/mxt010] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 12/20/2022] Open
Abstract
To assess the joint relationships among body mass index, menopausal status, and breast cancer according to breast cancer subtype and estrogen-progestin medication use, we conducted a meta-analysis of 89 epidemiologic reports published in English during 1980-2012 identified through a systematic search of bibliographic databases. Pooled analysis yielded a summary risk ratio of 0.78 (95% confidence interval (CI): 0.67, 0.92) for hormone receptor-positive premenopausal breast cancer associated with obesity (body mass index (weight (kg)/height (m)(2)) ≥30 compared with <25). Obesity was associated with a summary risk ratio of 1.39 (95% CI: 1.14, 1.70) for receptor-positive postmenopausal breast cancer. For receptor-negative breast cancer, the summary risk ratios of 1.06 (95% CI: 0.70, 1.60) and 0.98 (95% CI: 0.78, 1.22) associated with obesity were null for both premenopausal and postmenopausal women, respectively. Elevated postmenopausal breast cancer risk ratios associated with obesity were limited to women who never took estrogen-progestin therapy, with risk ratios of 1.42 (95% CI: 1.30, 1.55) among never users and 1.18 (95% CI: 0.98, 1.42) among users; too few studies were available to examine this relationship according to receptor subtype. Future research is needed to confirm whether obesity is unrelated to receptor-negative breast cancer in populations of postmenopausal women with low prevalence of hormone medication use.
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Affiliation(s)
| | | | | | | | - Amy Trentham-Dietz
- Correspondence to Dr. Amy Trentham-Dietz, University of Wisconsin, 610 Walnut Street, WARF Room 307, Madison, WI 53726 (e-mail: )
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44
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Powell M, Jamshidian F, Cheyne K, Nititham J, Prebil LA, Ereman R. Assessing breast cancer risk models in Marin County, a population with high rates of delayed childbirth. Clin Breast Cancer 2013; 14:212-220.e1. [PMID: 24461459 DOI: 10.1016/j.clbc.2013.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 10/28/2013] [Accepted: 11/17/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION This study was designed to compare the Breast Cancer Risk Assessment Tool (BCRAT; Gail), International Breast Intervention Study (IBIS; Tyrer-Cuzick), and BRCAPRO breast cancer risk assessment models using data from the Marin Women's Study, a cohort of women within Marin County, California, with high rates of breast cancer, nulliparity, and delayed childbirth. Existing models have not been well-validated in these high-risk populations. METHODS Discrimination was assessed using the area under the receiver operating characteristic curve (AUC) and calibration by estimating the ratio of expected-to-observed (E/O) cases. The models were assessed using data from 12,843 participants, of whom 203 had developed cancer during a 5-year period. All tests of statistical significance were 2-sided. RESULTS The IBIS model achieved an AUC of 0.65 (95% confidence interval [CI], 0.61-0.68) compared with 0.62 (95% CI, 0.59-0.66) for BCRAT and 0.60 (95% CI, 0.56-0.63) for BRCAPRO. The corresponding estimated E/O ratios for the models were 1.08 (95% CI, 0.95-1.25), 0.81 (95% CI, 0.71-0.93), and 0.59 (95% CI, 0.52-0.68). In women with age at first birth > 30 years, the AUC for the IBIS, BCRAT, and BRCAPRO models was 0.69 (95% CI, 0.62-0.75), 0.63 (95% CI, 0.56-0.70), and 0.62 (95% CI, 0.56-0.68) and the E/O ratio was 1.15 (95% CI, 0.89-1.47), 0.81 (95% CI, 0.63-1.05), and 0.53 (95% CI, 0.41-0.68), respectively. CONCLUSIONS The IBIS model was well calibrated for the high-risk Marin mammography population and demonstrated the best calibration of the 3 models in nulliparous women. The IBIS model also achieved the greatest overall discrimination and displayed superior discrimination for women with age at first birth > 30 years.
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Affiliation(s)
- Mark Powell
- Marin Women's Study, Marin County Health and Human Services, San Rafael, CA.
| | - Farid Jamshidian
- Marin Women's Study, Marin County Health and Human Services, San Rafael, CA
| | - Kate Cheyne
- Marin Women's Study, Marin County Health and Human Services, San Rafael, CA
| | - Joanne Nititham
- Marin Women's Study, Marin County Health and Human Services, San Rafael, CA
| | - Lee Ann Prebil
- Marin Women's Study, Marin County Health and Human Services, San Rafael, CA
| | - Rochelle Ereman
- Marin Women's Study, Marin County Health and Human Services, San Rafael, CA
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Pu X, Ye Y, Wu X. Development and validation of risk models and molecular diagnostics to permit personalized management of cancer. Cancer 2013; 120:11-9. [PMID: 24114238 DOI: 10.1002/cncr.28393] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/25/2013] [Accepted: 08/29/2013] [Indexed: 01/29/2023]
Abstract
Despite the advances made in cancer management over the past few decades, improvements in cancer diagnosis and prognosis are still poor, highlighting the need for individualized strategies. Toward this goal, risk prediction models and molecular diagnostic tools have been developed, tailoring each step of risk assessment from diagnosis to treatment and clinical outcomes based on the individual's clinical, epidemiological, and molecular profiles. These approaches hold increasing promise for delivering a new paradigm to maximize the efficiency of cancer surveillance and efficacy of treatment. However, they require stringent study design, methodology development, comprehensive assessment of biomarkers and risk factors, and extensive validation to ensure their overall usefulness for clinical translation. In the current study, the authors conducted a systematic review using breast cancer as an example and provide general guidelines for risk prediction models and molecular diagnostic tools, including development, assessment, and validation.
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Affiliation(s)
- Xia Pu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Espié M, Wassermann J, de Kermadec E, Lalloum M, Coussy F. Vitamine D et cancers. Presse Med 2013; 42:1405-11. [DOI: 10.1016/j.lpm.2013.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/24/2013] [Accepted: 07/24/2013] [Indexed: 12/22/2022] Open
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Wang J, Scholtens D, Holko M, Ivancic D, Lee O, Hu H, Chatterton RT, Sullivan ME, Hansen N, Bethke K, Zalles CM, Khan SA. Lipid metabolism genes in contralateral unaffected breast and estrogen receptor status of breast cancer. Cancer Prev Res (Phila) 2013; 6:321-30. [PMID: 23512947 DOI: 10.1158/1940-6207.capr-12-0304] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Risk biomarkers that are specific to estrogen receptor (ER) subtypes of breast cancer would aid the development and implementation of distinct prevention strategies. The contralateral unaffected breast of women with unilateral breast cancer (cases) is a good model for defining subtype-specific risk because women with ER-negative (ER-) index primaries are at high risk for subsequent ER-negative primary cancers. We conducted random fine needle aspiration of the unaffected breasts of cases. Samples from 30 subjects [15 ER-positive (ER+) and 15 ER- cases matched for age, race and menopausal status] were used for Illumina expression array analysis. Findings were confirmed using quantitative real-time PCR (qRT-PCR) in the same samples. A validation set consisting of 36 subjects (12 ER+, 12 ER- and 12 standard-risk healthy controls) was used to compare gene expression across groups. ER- case samples displayed significantly higher expression of 18 genes/transcripts, 8 of which were associated with lipid metabolism on gene ontology analysis (GO: 0006629). This pattern was confirmed by qRT-PCR in the same samples, and in the 24 cases of the validation set. When compared to the healthy controls in the validation set, significant overexpression of 4 genes (DHRS2, HMGCS2, HPGD and ACSL3) was observed in ER- cases, with significantly lower expression of UGT2B11 and APOD in ER+ cases, and decreased expression of UGT2B7 in both subtypes. These data suggest that differential expression of lipid metabolism genes may be involved in the risk for subtypes of breast cancer, and are potential biomarkers of ER-specific breast cancer risk.
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Affiliation(s)
- Jun Wang
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Boggs DA, Rosenberg L, Pencina MJ, Adams-Campbell LL, Palmer JR. Validation of a breast cancer risk prediction model developed for Black women. J Natl Cancer Inst 2013; 105:361-7. [PMID: 23411594 DOI: 10.1093/jnci/djt008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A breast cancer risk prediction model for black women, developed from data in the Women's Contraceptive and Reproductive Experiences (CARE) study, has been validated in women aged 50 years or older but not among younger women or for specific breast cancer subtypes. METHODS We assessed calibration and discrimination of the CARE model in the Black Women's Health Study (BWHS) with data from 45 942 women aged 30 to 69 years at baseline. RESULTS During a mean follow-up of 9.5 years, we identified 852 invasive breast cancers. The CARE model predicted 749.6 breast cancers, yielding an expected-to-observed (E/O) ratio of 0.88 (95% confidence interval [CI] = 0.82 to 0.94). The E/O ratio did not appreciably differ between women aged less than 50 years and those aged 50 years or older. The model underpredicted risk to the greatest degree among women aged 25 years or older at birth of first child (E/O = 0.71, 95% CI = 0.63 to 0.81); the model was well calibrated among women aged less than 25 years at birth of first child. The prevalence of later age at birth of first child was higher in the BWHS than in the CARE study, and breast cancer incidence was higher in the BWHS compared with national rates used in the CARE model. With respect to discriminatory accuracy, the concordance statistic was 0.57 (95% CI = 0.55 to 0.59) for breast cancer overall, 0.59 (95% CI = 0.57 to 0.61) for estrogen receptor (ER)-positive breast cancer, and 0.54 (95% CI = 0.50 to 0.57) for ER-negative breast cancer. CONCLUSIONS The CARE model underpredicted breast cancer risk in the BWHS, at least in part because of older age at first birth in this cohort, which led to higher breast cancer incidence rates. Our results suggest that inclusion of age at first birth may improve model performance. Discriminatory accuracy was modest and worse for ER-negative breast cancer.
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Affiliation(s)
- Deborah A Boggs
- Slone Epidemiology Center, 1010 Commonwealth Ave, Boston, MA 02215, USA.
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Pastor-Barriuso R, Ascunce N, Ederra M, Erdozáin N, Murillo A, Alés-Martínez JE, Pollán M. Recalibration of the Gail model for predicting invasive breast cancer risk in Spanish women: a population-based cohort study. Breast Cancer Res Treat 2013; 138:249-59. [PMID: 23378108 PMCID: PMC3586062 DOI: 10.1007/s10549-013-2428-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/21/2013] [Indexed: 01/10/2023]
Abstract
The Gail model for predicting the absolute risk of invasive breast cancer has been validated extensively in US populations, but its performance in the international setting remains uncertain. We evaluated the predictive accuracy of the Gail model in 54,649 Spanish women aged 45-68 years who were free of breast cancer at the 1996-1998 baseline mammographic examination in the population-based Navarre Breast Cancer Screening Program. Incident cases of invasive breast cancer and competing deaths were ascertained until the end of 2005 (average follow-up of 7.7 years) through linkage with population-based cancer and mortality registries. The Gail model was tested for calibration and discrimination in its original form and after recalibration to the lower breast cancer incidence and risk factor prevalence in the study cohort, and compared through cross-validation with a Navarre model fully developed from this cohort. The original Gail model overpredicted significantly the 835 cases of invasive breast cancer observed in the cohort (ratio of expected to observed cases 1.46, 95 % CI 1.36-1.56). The recalibrated Gail model was well calibrated overall (expected-to-observed ratio 1.00, 95 % CI 0.94-1.07), but it tended to underestimate risk for women in low-risk quintiles and to overestimate risk in high-risk quintiles (P = 0.01). The Navarre model showed good cross-validated calibration overall (expected-to-observed ratio 0.98, 95 % CI 0.92-1.05) and in different cohort subsets. The Navarre and Gail models had modest cross-validated discrimination indexes of 0.542 (95 % CI 0.521-0.564) and 0.544 (95 % CI 0.523-0.565), respectively. Although the original Gail model cannot be applied directly to populations with different underlying rates of invasive breast cancer, it can readily be recalibrated to provide unbiased estimates of absolute risk in such populations. Nevertheless, its limited discrimination ability at the individual level highlights the need to develop extended models with additional strong risk factors.
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Affiliation(s)
- Roberto Pastor-Barriuso
- National Center for Epidemiology, Carlos III Institute of Health, Monforte de Lemos 5, 28029 Madrid, Spain.
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Genkinger JM, Makambi KH, Palmer JR, Rosenberg L, Adams-Campbell LL. Consumption of dairy and meat in relation to breast cancer risk in the Black Women's Health Study. Cancer Causes Control 2013; 24:675-84. [PMID: 23329367 DOI: 10.1007/s10552-013-0146-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/04/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Dairy and meat consumption may impact breast cancer risk through modification of hormones (e.g., estrogen), through specific nutrients (e.g., vitamin D), or through products formed in processing/cooking (e.g., heterocyclic amines). Results relating meat and dairy intake to breast cancer risk have been conflicting. Thus, we examined the risk of breast cancer in relation to intake of dairy and meat in a large prospective cohort study. METHODS In the Black Women's Health Study, 1,268 incident breast cancer cases were identified among 52,062 women during 12 years of follow-up. Multivariable (MV) relative risks (RRs) and 95 % confidence intervals (CIs) were calculated using Cox proportional hazards models. RESULTS Null associations were observed for total milk (MV RR = 1.05, 95 % CI 0.74-1.46 comparing ≥1,000-0 g/week) and total meat (MV RR = 1.04, 95 % CI 0.85-1.28 comparing ≥1,000 < 400 g/week) intake and risk of breast cancer. Associations with intakes of specific types of dairy, specific types of meat, and dietary calcium and vitamin D were also null. The associations were not modified by reproductive (e.g., parity) or lifestyle factors (e.g., smoking). Associations with estrogen receptor (ER) positive (+), ER negative (-), progesterone receptor (PR) +, PR-, ER+/PR+, and ER-/PR- breast cancer were generally null. CONCLUSIONS This analysis of African-American women provides little support for associations of dairy and meat intake with breast cancer risk.
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Affiliation(s)
- Jeanine M Genkinger
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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