Breast Cancer Risk Model Requirements for Counseling, Prevention, and Screening

Journal of the National Cancer Institute
Mitchell H Gail, Ruth M Pfeiffer

Abstract

Incorporation of polygenic risk scores and mammographic density into models to predict breast cancer incidence can increase discriminatory accuracy (area under the receiver operating characteristic curve [AUC]) from 0.6 for models based only on epidemiologic factors to 0.7. It is timely to assess what impact these improvements will have on individual counseling and on public health prevention and screening strategies, and to determine what further improvements are needed. We studied various clinical and public health applications using a log-normal distribution of risk. Provided they are well calibrated, even risk models with AUCs of 0.6 to 0.7 provide useful perspective for individual counseling and for weighing the harms and benefits of preventive interventions in the clinic. At the population level, they are helpful for designing preventive intervention trials, for assessing reductions in absolute risk from reducing exposure to modifiable risk factors, and for resource allocation (although a higher AUC would be desirable for risk-based allocation). Other public health applications require higher AUCs that can only be achieved with risk predictors 1.6 to 8.8 times as strong as all those yet discovered combined. Such applicati...Continue Reading

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Citations

Feb 24, 2019·Breast Cancer Research and Treatment·Jeffrey A TiceKarla Kerlikowske
Aug 29, 2019·Arquivos De Gastroenterologia·Cláudia Alves CoutoTiago Sevá-Pereira
Sep 27, 2019·Journal of the National Cancer Institute·Mitchel H Gail
Jun 9, 2020·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·Ruth M PfeifferThomas R O'Brien
Sep 4, 2019·JAMA : the Journal of the American Medical Association·Lydia E Pace, Nancy L Keating
Dec 19, 2019·Breast Cancer Research : BCR·Daniele GiardielloMarjanka K Schmidt
Jun 20, 2020·Statistical Methods in Medical Research·Mitchell H Gail, David Pee
May 20, 2018·Cancer Prevention Research·Christine M Friedenreich, Anne McTiernan
Dec 6, 2020·Alcoholism, Clinical and Experimental Research·Julie A KableUNKNOWN CIFASD
Mar 24, 2021·International Journal of Epidemiology·Amber N HursonUNKNOWN B-CAST Risk Modelling Group
Jun 25, 2021·Cancer Prevention Research·Anne S QuanteRuth M Pfeiffer
Aug 8, 2021·Journal of Clinical Medicine·Gisella GennaroFrancesca Caumo
Oct 9, 2021·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Julie R PalmerLudovic Trinquart

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