Article

Using clinical factors and mammographic breast density to estimate breast cancer risk: development and validation of a new predictive model.

Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California 94143-1732, USA.
Annals of internal medicine (Impact Factor: 16.1). 04/2008; 148(5):337-47.
Source: PubMed

ABSTRACT Current models for assessing breast cancer risk are complex and do not include breast density, a strong risk factor for breast cancer that is routinely reported with mammography.
To develop and validate an easy-to-use breast cancer risk prediction model that includes breast density.
Empirical model based on Surveillance, Epidemiology, and End Results incidence, and relative hazards from a prospective cohort.
Screening mammography sites participating in the Breast Cancer Surveillance Consortium.
1,095,484 women undergoing mammography who had no previous diagnosis of breast cancer.
Self-reported age, race or ethnicity, family history of breast cancer, and history of breast biopsy. Community radiologists rated breast density by using 4 Breast Imaging Reporting and Data System categories.
During 5.3 years of follow-up, invasive breast cancer was diagnosed in 14,766 women. The breast density model was well calibrated overall (expected-observed ratio, 1.03 [95% CI, 0.99 to 1.06]) and in racial and ethnic subgroups. It had modest discriminatory accuracy (concordance index, 0.66 [CI, 0.65 to 0.67]). Women with low-density mammograms had 5-year risks less than 1.67% unless they had a family history of breast cancer and were older than age 65 years.
The model has only modest ability to discriminate between women who will develop breast cancer and those who will not.
A breast cancer prediction model that incorporates routinely reported measures of breast density can estimate 5-year risk for invasive breast cancer. Its accuracy needs to be further evaluated in independent populations before it can be recommended for clinical use.

0 Followers
 · 
100 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Twenty-one states have laws requiring that women be notified if they have dense breasts and that they be advised to discuss supplemental imaging with their provider. To better direct discussions of supplemental imaging by determining which combinations of breast cancer risk and Breast Imaging Reporting and Data System (BI-RADS) breast density categories are associated with high interval cancer rates. Prospective cohort. Breast Cancer Surveillance Consortium (BCSC) breast imaging facilities. 365 426 women aged 40 to 74 years who had 831 455 digital screening mammography examinations. BI-RADS breast density, BCSC 5-year breast cancer risk, and interval cancer rate (invasive cancer ≤12 months after a normal mammography result) per 1000 mammography examinations. High interval cancer rate was defined as more than 1 case per 1000 examinations. High interval cancer rates were observed for women with 5-year risk of 1.67% or greater and extremely dense breasts or 5-year risk of 2.50% or greater and heterogeneously dense breasts (24% of all women with dense breasts). The interval rate of advanced-stage disease was highest (>0.4 case per 1000 examinations) among women with 5-year risk of 2.50% or greater and heterogeneously or extremely dense breasts (21% of all women with dense breasts). Five-year risk was low to average (0% to 1.66%) for 51.0% of women with heterogeneously dense breasts and 52.5% with extremely dense breasts, with interval cancer rates of 0.58 to 0.63 and 0.72 to 0.89 case per 1000 examinations, respectively. The benefit of supplemental imaging was not assessed. Breast density should not be the sole criterion for deciding whether supplemental imaging is justified because not all women with dense breasts have high interval cancer rates. BCSC 5-year risk combined with BI-RADS breast density can identify women at high risk for interval cancer to inform patient-provider discussions about alternative screening strategies. National Cancer Institute.
    Annals of internal medicine 05/2015; 162(10):673-681. DOI:10.7326/M14-1465 · 16.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many states have laws requiring mammography facilities to tell women with dense breasts and a negative screening mammography result to discuss supplemental screening tests with their providers. The most readily available supplemental screening method is ultrasonography, but little is known about its effectiveness. To evaluate the benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts. Comparative modeling with 3 validated simulation models. Surveillance, Epidemiology, and End Results Program; Breast Cancer Surveillance Consortium; and medical literature. Contemporary cohort of women eligible for routine screening. Lifetime. Payer. Supplemental ultrasonography screening for women with dense breasts after a negative screening mammography result. Breast cancer deaths averted, quality-adjusted life-years (QALYs) gained, biopsies recommended after a false-positive ultrasonography result, and costs. Supplemental ultrasonography screening after a negative mammography result for women aged 50 to 74 years with heterogeneously or extremely dense breasts averted 0.36 additional breast cancer deaths (range across models, 0.14 to 0.75 deaths), gained 1.7 QALYs (range, 0.9 to 4.7 QALYs), and resulted in 354 biopsy recommendations after a false-positive ultrasonography result (range, 345 to 421 recommendations) per 1000 women with dense breasts compared with biennial screening by mammography alone. The cost-effectiveness ratio was $325 000 per QALY gained (range, $112 000 to $766 000 per QALY gained). Supplemental ultrasonography screening for only women with extremely dense breasts cost $246 000 per QALY gained (range, $74 000 to $535 000 per QALY gained). The conclusions were not sensitive to ultrasonography performance characteristics, screening frequency, or starting age. Provider costs for coordinating supplemental ultrasonography were not considered. Supplemental ultrasonography screening for women with dense breasts would substantially increase costs while producing relatively small benefits. National Cancer Institute.
    Annals of internal medicine 12/2014; 162(3). DOI:10.7326/M14-0692 · 16.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Endogenous hormones are risk factors for postmenopausal breast cancer, and their measurement may improve our ability to identify high-risk women. Therefore, we evaluated whether inclusion of plasma estradiol, estrone, estrone sulfate, testosterone, dehydroepiandrosterone sulfate, prolactin, and sex hormone-binding globulin (SHBG) improved risk prediction for postmenopausal invasive breast cancer (n = 437 patient cases and n = 775 controls not using postmenopausal hormones) in the Nurses' Health Study.
    Journal of Clinical Oncology 08/2014; 32(28). DOI:10.1200/JCO.2014.56.1068 · 17.88 Impact Factor