Projecting Individualized Probabilities of Developing Breast Cancer for White Females Who Are Being Examined Annually

Abstract

To assist in medical counseling, we present a method to estimate the chance that a woman with given age and risk factors will develop breast cancer over a specified interval. The risk factors used were age at menarche, age at first live birth, number of previous biopsies, and number of first-degree relatives with breast cancer. A model of relative risks for various combinations of these factors was developed from case-control data from the Breast Cancer Detection Demonstration Project (BCDDP). The model allowed for the fact that relative risks associated with previous breast biopsies were smaller for women aged 50 or more than for younger women. Thus, the proportional hazards models for those under age 50 and for those of age 50 or more. The baseline age-specific hazard rate, which is the rate for a patient without identified risk factors, is computed as the product of the observed age-specific composite hazard rate times the quantity 1 minus the attributable risk. We calculated individualized breast cancer probabilities from information on relative risks and the baseline hazard rate. These calculations take competing risks and the interval of risk into account. Our data were derived from women who participated in the BCDDP and who tended to return for periodic examinations. For this reason, the risk projections given are probably most reliable for counseling women who plan to be examined about once a year.

Breast magnetic resonance image screening and ductal lavage in women at high genetic risk for breast carcinoma

“…39 A modification of the Gail model, which is used widely for estimating breast carcinoma risk, has included a multiplication factor to reflect the recognized contribution of a patient's prior history of atypical hyperplasia. 40 Two groups have evaluated the prevalence of high-risk lesions (including ALH, atypical ductal hyperplasia, lobular carcinoma in situ, and DCIS) in prophylactic mastectomy specimens from women who were at increased genetic risk and found incidences of 46% and 57%. 41,42 Those study populations were comparable to ours with regard to age, BRCA1/ BRCA2 mutation status, and prior risk reduction with tamoxifen and/or BSO.…”

The Angelina effect: immediate reach, grasp, and impact of going public

“…This way of assessing family history is consistent with models of family risk assessment that focused on personal cancer history and the number of affected paternal and maternal first, second, and third degree of relatives. [13][14][15] Using the format suggested by Lipkus, 16 female respondents were asked to estimate their own lifetime breast or ovarian cancer risk, and males were asked to estimate a female relative's lifetime risk of developing these types of cancers, compared with others of their same race and age, indicating if they thought their risk (or a family member's risk) was higher, the same, or lower. We used a modification of Schwartz et al 's 17 three-item measure of numeracy previously used in a study of screening for mammography.…”

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

“…14,15,17 The Breast Cancer Risk Assessment Tool (aka Gail model) estimated the lifetime risk for the vignette patients with the greatest breast cancer risk (i.e., vignette that included family history of mother with post-menopausal breast cancer) as 10.4 % for the African American woman vs. 8.7 % for the average (age and race/ethnicity matched) woman and 14.5 % for the Caucasian woman vs. 11 % for the average (age and race/ethnicity matched) woman. [31][32][33] There were three categories of guideline-inconsistent breast cancer screening: 1) extra testing (offering a non-recommended screening modality [breast ultrasound and/or breast MRI] "almost always" or "sometimes" in addition to offering mammography "almost always"); 2) insufficient testing ("almost never" or "sometimes" offering mammography, and "almost never" offering a non-recommended screening modality); and 3) wrong testing (offering a non-recommended screening modality "almost always" or "sometimes", and "almost never" offering mammography).…”