Abstract
PurposeWe evaluated the performance of the Gail model for a Korean population and developed a Korean breast cancer risk assessment tool (KoBCRAT) based upon equations developed for the Gail model for predicting breast cancer risk.MethodsUsing 3,789 sets of cases and controls, risk factors for breast cancer among Koreans were identified. Individual probabilities were projected using Gail's equations and Korean hazard data. We compared the 5-year and lifetime risk produced using the modified Gail model which applied Korean incidence and mortality data and the parameter estimators from the original Gail model with those produced using the KoBCRAT. We validated the KoBCRAT based on the expected/observed breast cancer incidence and area under the curve (AUC) using two Korean cohorts: the Korean Multicenter Cancer Cohort (KMCC) and National Cancer Center (NCC) cohort.ResultsThe major risk factors under the age of 50 were family history, age at menarche, age at first full-term pregnancy, menopausal status, breastfeeding duration, oral contraceptive usage, and exercise, while those at and over the age of 50 were family history, age at menarche, age at menopause, pregnancy experience, body mass index, oral contraceptive usage, and exercise. The modified Gail model produced lower 5-year risk for the cases than for the controls (p = 0.017), while the KoBCRAT produced higher 5-year and lifetime risk for the cases than for the controls (p<0.001 and <0.001, respectively). The observed incidence of breast cancer in the two cohorts was similar to the expected incidence from the KoBCRAT (KMCC, p = 0.880; NCC, p = 0.878). The AUC using the KoBCRAT was 0.61 for the KMCC and 0.89 for the NCC cohort.ConclusionsOur findings suggest that the KoBCRAT is a better tool for predicting the risk of breast cancer in Korean women, especially urban women.
Highlights
Breast cancer is the second most common malignancy among women in Korea
A family history of breast cancer in firstdegree relatives, age at menarche, age at menopause, experience of pregnancy, body mass index (BMI), oral contraceptive usage, and exercise are included in the final model among women aged $50 years
We developed a breast cancer risk assessment tool and conducted validation with two cohorts
Summary
Breast cancer is the second most common malignancy among women in Korea. The incidence of breast cancer is increasing rapidly, at an average rate second only to that of thyroid cancer. In 2009, 13,399 new female cases of breast cancer developed and 1,878 women died of this disease [1]. Several breast cancer screening modalities are currently available, including clinical breast examination, mammography, breast ultrasonography, and breast magnetic resonance imaging. Given the high incidence of breast cancer, its significance, and the various available screening tests, a model estimating an individual’s risk of developing breast cancer that could be applied in the clinical setting may be useful for recommending supplementary screening tests and conducting chemoprevention or screening intervention trials [2]
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