Personalized estimates of breast cancer risk in clinical practice and public health

被引:60
作者
Gail, Mitchell H. [1 ]
机构
[1] NCI, Biostat Branch, Div Canc Epidemiol & Genet, Bethesda, MD 20892 USA
基金
美国国家卫生研究院;
关键词
absolute risk; allocation of prevention resources; breast cancer; calibration; crude risk; cumulative incidence; discriminatory accuracy; disease prevention; designing disease prevention trials; high-risk prevention strategy; risk versus benefit; PROPHYLACTIC MASTECTOMY; POSTMENOPAUSAL WOMEN; PREDICTION; VALIDATION; MODEL; PREVENTION; DISEASE; CURVE; SUSCEPTIBILITY; PERFORMANCE;
D O I
10.1002/sim.4187
中图分类号
Q [生物科学];
学科分类号
07 ; 0710 ; 09 ;
摘要
This paper defines absolute risk and some of its properties, and presents applications in breast cancer counseling and prevention. For counseling, estimates of absolute risk give useful perspective and can be used in management decisions that require weighing risks and benefits, such as whether or not to take tamoxifen to prevent breast cancer. Absolute risk models are also useful in designing intervention trials to prevent breast cancer and in assessing the potential reductions in absolute risk of disease that might result from reducing exposures that are associated with breast cancer. In these applications, it is important that the risk model be well calibrated, namely that it accurately predicts the numbers of women who will develop breast cancer in various subsets of the population. Absolute risk models are also needed to implement a 'high risk' prevention strategy that identifies a high-risk subset of the population and focuses intervention efforts on that subset. The limitations of the high-risk strategy are discussed, including the need for risk models with high discriminatory accuracy, and the need for less toxic interventions that can reduce the threshold of risk above which the intervention provides a net benefit. I also discuss the potential use of risk models in allocating prevention resources under cost constraints. High discriminatory accuracy of the risk model, in addition to good calibration, is desirable in this application, and the risk assessment should not be expensive in comparison with the intervention. Published in 2011 by John Wiley & Sons, Ltd.
引用
收藏
页码:1090 / 1104
页数:15
相关论文
共 66 条
[1]   Assessing Women at High Risk of Breast Cancer: A Review of Risk Assessment Models [J].
Amir, Eitan ;
Freedman, Orit C. ;
Seruga, Bostjan ;
Evans, D. Gareth .
JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2010, 102 (10) :680-691
[2]  
[Anonymous], 2009, Ann Intern Med, V151, pI, DOI 10.7326/0003-4819-151-9-200911030-00002
[3]  
[Anonymous], 2003, The Statistical Evaluation of Medical Tests for Classification and Prediction
[4]   The BOADICEA model of genetic susceptibility to breast and ovarian cancers: updates and extensions [J].
Antoniou, A. C. ;
Cunningham, A. P. ;
Peto, J. ;
Evans, D. G. ;
Lalloo, F. ;
Narod, S. A. ;
Risch, H. A. ;
Eyfjord, J. E. ;
Hopper, J. L. ;
Southey, M. C. ;
Olsson, H. ;
Johannsson, O. ;
Borg, A. ;
Passini, B. ;
Radice, P. ;
Manoukian, S. ;
Eccles, D. M. ;
Tang, N. ;
Olah, E. ;
Anton-Culver, H. ;
Warner, E. ;
Lubinski, J. ;
Gronwald, J. ;
Gorski, B. ;
Tryggvadottir, L. ;
Syrjakoski, K. ;
Kallioniemi, O-P ;
Eerola, H. ;
Nevanlinna, H. ;
Pharoah, P. D. P. ;
Easton, D. F. .
BRITISH JOURNAL OF CANCER, 2008, 98 (08) :1457-1466
[5]   THE AGE DISTRIBUTION OF CANCER AND A MULTI-STAGE THEORY OF CARCINOGENESIS [J].
ARMITAGE, P ;
DOLL, R .
BRITISH JOURNAL OF CANCER, 1954, 8 (01) :1-12
[6]   Using relative utility curves to evaluate risk prediction [J].
Baker, Stuart G. ;
Cook, Nancy R. ;
Vickers, Andrew ;
Kramer, Barnett S. .
JOURNAL OF THE ROYAL STATISTICAL SOCIETY SERIES A-STATISTICS IN SOCIETY, 2009, 172 :729-748
[7]   BRCAPRO validation, sensitivity of genetic testing of BRCA1/BRCA2, and prevalence of other breast cancer susceptibility genes [J].
Berry, DA ;
Iversen, ES ;
Gudbjartsson, DF ;
Hiller, EH ;
Garber, JE ;
Peshkin, BN ;
Lerman, C ;
Watson, P ;
Lynch, HT ;
Hilsenbeck, SG ;
Rubinstein, WS ;
Hughes, KS ;
Parmigiani, G .
JOURNAL OF CLINICAL ONCOLOGY, 2002, 20 (11) :2701-2712
[8]   ESTIMATING THE POPULATION ATTRIBUTABLE RISK FOR MULTIPLE RISK-FACTORS USING CASE-CONTROL DATA [J].
BRUZZI, P ;
GREEN, SB ;
BYAR, DP ;
BRINTON, LA ;
SCHAIRER, C .
AMERICAN JOURNAL OF EPIDEMIOLOGY, 1985, 122 (05) :904-913
[9]   Cancer epidemiology and control in Taiwan: a brief review [J].
Chen, CJ ;
You, SL ;
Lin, LH ;
Hsu, WL ;
Yang, YW .
JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 2002, 32 :S66-S81
[10]   Projecting absolute invasive breast cancer risk in white women with a model that includes mammographic density [J].
Chen, Jinbo ;
Pee, David ;
Ayyagari, Rajeev ;
Graubard, Barry ;
Schairer, Catherine ;
Byrne, Celia ;
Benichou, Jacques ;
Gail, Mitchell H. .
JOURNAL OF THE NATIONAL CANCER INSTITUTE, 2006, 98 (17) :1215-1226