Abstract
Abstract Purpose Commonly used breast cancer risk models estimate breast cancer incidence. However, such model performance, re-purposed to predict breast cancer mortality, are largely unknown. Therefore, we examined whether the BCRAT model predicts long-term breast cancer mortality in postmenopausal women in the WHI. Participants and Methods Of 161,808 WHI participants aged 50-79 years, after exclusions,145,408 were in the analysis. BCRAT risk was calculated, with incident breast cancers verified by central medical record review. Breast cancer mortality was related to BCRAT 5-year risk groups (< 1%, 1-2.99%, ≥ 3%) using unadjusted Cox proportional hazard models and in age-stratified, multi-variable models. An addition analysis compared proportion of participants with BCRAT risk ≥ 1.67% and ≥ 3% (former and current prevention thresholds). Results Of 145,408 participants, the ≥1.67% and the ≥3.0% risk groups included 40% and 9% of participants, respectively. Compared to women with BCRAT<1% risk, women with BCRAT ≥ 3% risk had more common breast cancer family history and lower BMI. After 20 years median follow-up, with 8,849 breast cancers and 1,076 deaths from breast cancer, risk of death from breast cancer in BCRAT risk group ≥ 3% was not higher compared to BCRAT risk group <1%. (Hazard Ratio [HR] 1.06 95% Confidence Interval [CI] 0.80-1.40, P = 0.76). Similarly, risk of death from breast cancer in BCRAT risk group 1-2.99% was not higher compared to BCRAT risk group <1 (HR 1.15 95% CI 0.93-1.43). Conclusions Current guideline recommendation for threshold for endocrine-targeted interventions substantially reduces postmenopausal prevention candidates from 40% to <10%. The BCRAT prediction model, even at the ≥ 3% 5-year risk threshold, does not identify women at significantly increased risk of death from breast cancer. Citation Format: Rebecca Nelson, Kathy Pan, Rowan Chlebowski, Thomas E Rohan, Joanne Mortimer, Jean Wactawski-Wende, Dorothy Lane, Laura Kruper. Breast cancer risk assessment tool (BCRAT) predicted breast cancer incidence and breast cancer mortality in the women's health initiative [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-10-04.
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