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Saleh B, Elhawary MA, Mohamed ME, Ali IN, El Zayat MS, Mohamed H. Gail model utilization in predicting breast cancer risk in Egyptian women: a cross-sectional study. Breast Cancer Res Treat 2021; 188:749-758. [PMID: 33852122 DOI: 10.1007/s10549-021-06200-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Herein, our purpose was to calculate the 5-year and lifetime risk of breast cancer and to assess new breast cancer potential contributors among Egyptian women utilizing the modified Gail model, while presenting a global comparison of risk assessment. METHODS This study included 7009 women from both urban and rural areas scattered across 40% of the Egyptian provinces. The 5-year risk categories were defined as low risk (≤ 1.66%) or high risk (> 1.66%), whereas the lifetime risk categories were defined as low risk (≤ 20%) or high risk (> 20%). Pearson's Chi-squared test was performed to determine the association between participants' characteristics and distinct risk categories. Binary logistic regression was carried out for correlation analysis. RESULTS The mean estimated risk for developing invasive breast cancer over 5 years was 0.86 (± 0.67), whereas the mean lifetime breast cancer risk score was 11.26 (± 5.7). Accordingly, only 614 (8.75%) and 470 (6.7%) women were categorized as individuals with high risk of breast cancer incidence in 5-year and lifetime, respectively. Only 192 participants (2.7%) conferred both high 5-year and high lifetime risk scores. Marital status, method of feeding, physical activity behavior, contraceptive use, menopause and number of children were found to have a statistically significant association with both 5-year and lifetime breast cancer risk categories. CONCLUSION We revealed that modified Gail model had a well-fitting and discrimination accuracy in Egyptian women when compared with other countries.
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Affiliation(s)
- Basem Saleh
- Medical Oncology Department, Tanta Cancer Center, Ministry of Health, Tanta, Gharbiah, Egypt.,Medical Oncology Department, Aswan Oncology Center, Ministry of Health, Aswân, Egypt
| | - Mohamed A Elhawary
- International Society of Pharmacovigilance - Egypt Chapter, Cairo, Egypt.,Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Moataz E Mohamed
- Department of Pharmacy Practice, Faculty of Pharmacy, Helwan University, Cairo, Egypt
| | - Islam N Ali
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.,University of Glasgow, Glasgow, Scotland, UK
| | - Menna S El Zayat
- Diagnostic Radiology Department, Al Helal Hospital - Specialized Medical Centers, Cairo, Egypt
| | - Hadeer Mohamed
- Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. .,Department of Clinical Oncology, Ain Shams University Hospitals, Cairo, Egypt.
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Solikhah S, Nurdjannah S. Assessment of the risk of developing breast cancer using the Gail model in Asian females: A systematic review. Heliyon 2020; 6:e03794. [PMID: 32346636 PMCID: PMC7182726 DOI: 10.1016/j.heliyon.2020.e03794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/25/2020] [Accepted: 04/14/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Currently, the Breast Cancer Risk Assessment Tool (BCRAT), also known as the Gail model (GM) has been widely recognized and adapted for to study disparity in racial and ethnic groups in America including Asian and Pacific Islander American females. However, its applicability outside America remains uncertain due to diversity in epidemiology and risk factors of breast cancer in populations especially in Asian females. We sought to evaluate the performance of the GM to predict breast cancer risk in Asian countries. Material and methods This study identified articles published from 2010 by searching PubMed, MEDLINE, Scopus, Web of Science, Google Scholar and gray literature. The initial search terms were breast cancer, mammary, carcinoma, tumor, neoplasm, risk assessment tool, BCRAT, breast cancer prediction, Gail model, Asia, and Asian. Results The search yielded 20 articles, with 7 articles addressing the AUC and/or the expected (E) to observed (O) ratio of predicted breast cancer risk, representing the accuracy of the GM in the Asian population. One publication reported the sensitivity and specificity but no AUC. None of the studies were accepted as the standard for reporting prognostic models. Several studies reported good prognostic testing and likely developed a new model modifying the items in the instrument. Conclusion The results are not strong enough to develop breast cancer risk in the setting of Asian countries. Involving the breast cancer risk of the Asian population in developing a prognostic model with good statistical understanding is particularly important and can reduce flawed or biased models. Identifying the best methods to achieve well-suited prognostic models in the Asian population should be a priority.
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Affiliation(s)
- Solikhah Solikhah
- Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, 55166, Indonesia.,Dynamic Social Study Center, Universitas Ahmad Dahlan, Yogyakarta, 55166, Indonesia
| | - Sitti Nurdjannah
- Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, 55166, Indonesia
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Stevanato KP, Pedroso RB, Iora P, dos Santos L, Pelloso FC, de Melo WA, de Barros Carvalho MD, Pelloso SM. Comparative Analysis between the Gail, Tyrer-Cuzick and BRCAPRO Models for Breast Cancer Screening in Brazilian Population. Asian Pac J Cancer Prev 2019; 20:3407-3413. [PMID: 31759366 PMCID: PMC7063010 DOI: 10.31557/apjcp.2019.20.11.3407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/16/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To analyze the diagnostic accuracy of predictive models of breast cancer risk for the Brazilian population. METHOD A cross-sectional, study was conducted in a sample of 382 women aged 35-69 years who were users of the Unified Health System (SUS) residing in a municipality in southern Brazil. RESULTS The results showed that the Tyrer-Cuzick model had the highest mean risk values and estimates (proportion) for predicting the 5-year risk of breast cancer, reaching a maximum risk of ±1.63% in the 60-64 year age group. For the 90-year risk, a maximum risk of ±12.8% was predicted for the 50-54 year age group using this model. The 5-year risk calculated by the three tools increased progressively with increasing age, where the mean risk was ±0.8% in women aged 35-39 and reached ±1.50% in women aged 65-69. The 90-year risk declined with increasing age only in the Tyrer-Cuzick model, from ±10.8% to ±9%. The BRCAPRO model presented a greater sensitivity compared to the Gail and Tyrer-Cuzick models. And, the model that presented greater specificity was Gail. CONCLUSION The Tyrer-Cuzick model presented the highest risk estimates for 5 years and 90 years in the studied population, however, this data is not enough to validate this tool, since when analyzing the sensitivity and specificity the BRCAPRO and Gail have the highest values respectively.
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Affiliation(s)
| | | | | | - Lander dos Santos
- Master's Degree in Health Sciences of the Graduate Program in Health Sciences,
| | - Fernando Castilho Pelloso
- Lecturer at the Department of Medicine at Unicesumar University and Professor at the Department of Postgraduate Science in Health, State University of Maringá (UEM),
| | | | | | - Sandra Marisa Pelloso
- Lecturer at the Nursing Department of the Paraná State University, Paranavaí campus Brazil.
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Yang J, Lin W, Chen Y. Off-label use of tamoxifen in a Chinese tertiary care hospital. Int J Clin Pharm 2019; 41:555-562. [PMID: 30680514 DOI: 10.1007/s11096-019-00788-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
Abstract
Background Tamoxifen is an estrogen receptor modulator used for the treatment of breast cancer; however, currently, it is used in many off-label indications. Objective To investigate the prevalence of tamoxifen off-label prescribing and explore available scientific evidence that supports those uses in outpatients. Setting Xiamen maternity and child health care hospital in Xiamen city of China. Method All the prescriptions of outpatients receiving tamoxifen were exported from an electronic prescribing system during a 1-year period. Tamoxifen use was then classified as either on- or off-label according to the criteria we established previously, and the details of the off-label prescriptions were collected. Logistic regression was applied to explore predictive variables. Evidence search was limited to Up-To-Date, the Micromedex database and PubMed. Main outcome measure The rate of off-label use, risk factors identified by logistic regression and evidence exhibition. Results A total of 75% of all the prescriptions available were classified as off-label use. Hyperplasia of the breast was the most frequently prescribed off-label indication. According to the analysis of logistic regression, male patients, patients less than 34 years old, and physicians with a higher professional title were more likely associated with off-label prescribing. After a search in Up-To-Date, the Micromedex database and PubMed, only male infertility, atypical hyperplasia, mastodynia, peripheral precocious puberty and gynecomastia were found to have strong evidence supporting the use of tamoxifen off-label (22.75%). Conclusion Although the off-label use of tamoxifen was common in our hospital, there was a relative shortage of evidence available supporting those uses.
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Affiliation(s)
- Jianhui Yang
- Department of Pharmacy, Xiamen Maternity and Child Health Care Hospital, No. 10 Zhenhai Road, Xiamen, 361001, Fujian Province, China.
| | - Wubin Lin
- Department of Pharmacy, Xiamen Maternity and Child Health Care Hospital, No. 10 Zhenhai Road, Xiamen, 361001, Fujian Province, China
| | - Yao Chen
- Department of Pharmacy, Xiamen Maternity and Child Health Care Hospital, No. 10 Zhenhai Road, Xiamen, 361001, Fujian Province, China
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Bener A, Çatan F, El Ayoubi HR, Acar A, Ibrahim WH. Assessing Breast Cancer Risk Estimates Based on the Gail Model and Its Predictors in Qatari Women. J Prim Care Community Health 2017; 8:180-187. [PMID: 28606030 PMCID: PMC5932695 DOI: 10.1177/2150131917696941] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The Gail model is the most widely used breast cancer risk assessment tool. An accurate assessment of individual’s breast cancer risk is very important for prevention of the disease and for the health care providers to make decision on taking chemoprevention for high-risk women in clinical practice in Qatar. Aim: To assess the breast cancer risk among Arab women population in Qatar using the Gail model and provide a global comparison of risk assessment. Subjects and Methods: In this cross-sectional study of 1488 women (aged 35 years and older), we used the Gail Risk Assessment Tool to assess the risk of developing breast cancer. Sociodemographic features such as age, lifestyle habits, body mass index, breast-feeding duration, consanguinity among parents, and family history of breast cancer were considered as possible risks. Results: The mean age of the study population was 47.8 ± 10.8 years. Qatari women and Arab women constituted 64.7% and 35.3% of the study population, respectively. The mean 5-year and lifetime breast cancer risks were 1.12 ± 0.52 and 10.57 ± 3.1, respectively. Consanguineous marriage among parents was seen in 30.6% of participants. We found a relationship between the 5-year and lifetime risks of breast cancer and variables such as age, age at menarche, gravidity, parity, body mass index, family history of cancer, menopause age, occupation, and level of education. The linear regression analysis identified the predictors for breast cancer in women such as age, age at menarche, age of first birth, family history and age of menopausal were considered the strong predictors and significant contributing risk factors for breast cancer after adjusting for ethnicity, parity and other variables. Conclusion: The current study is the first to evaluate the performance of the Gail model for Arab women population in the Gulf Cooperation Council. Gail model is an appropriate breast cancer risk assessment tool for female population in Qatar.
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Affiliation(s)
- Abdulbari Bener
- 1 Cerrahpaşa Faculty of Medicine Istanbul University, Istanbul, Turkey.,2 University of Manchester, Manchester, UK.,3 Istanbul Medipol University, International School of Medicine, Istanbul, Turkey
| | - Funda Çatan
- 1 Cerrahpaşa Faculty of Medicine Istanbul University, Istanbul, Turkey.,4 University of Nottingham, Nottingham, UK
| | - Hanadi R El Ayoubi
- 5 Al Amal Hospital, Hamad Medical Corporation, Qatar.,6 Hospital Saint Louis, Paris, France
| | - Ahmet Acar
- 1 Cerrahpaşa Faculty of Medicine Istanbul University, Istanbul, Turkey
| | - Wanis H Ibrahim
- 7 Hamad General Hospital, Weill-Cornell Medical College, Qatar
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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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