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Evaluating breast cancer risk projections for Hispanic women.

Banegas MP; Gail MH; LaCroix A; Thompson B; Martinez ME; Wactawski-Wende J; John EM; Hubbell FA; Yasmeen S; Katki HA

Breast Cancer Res Treat 2012 Feb; 132(1):347-353

https://doi.org/10.1007/s10549-011-1900-9

20055420

For Hispanic women, the Breast Cancer Risk Assessment Tool (BCRAT; "Gail Model") combines 1990-1996 breast cancer incidence for Hispanic women with relative risks for breast cancer risk factors from non-Hispanic white (NHW) women. BCRAT risk projections have never been comprehensively evaluated for Hispanic women. We compared the relative risks and calibration of BCRAT risk projections for 6,353 Hispanic to 128,976 NHW postmenopausal participants aged 50 and older in the Women's Health Initiative (WHI). Calibration was assessed by the ratio of the number of breast cancers observed with that expected by the BCRAT (O/E). We re-evaluated calibration for an updated BCRAT that combined BCRAT relative risks with 1993-2007 breast cancer incidence that is contemporaneous with the WHI. Cox regression was used to estimate relative risks. Discriminatory accuracy was assessed using the concordance statistic (AUC). In the WHI Main Study, the BCRAT underestimated the number of breast cancers by 18% in both Hispanics (O/E = 1.18, P = 0.06) and NHWs (O/E = 1.18, P < 0.001). Updating the BCRAT improved calibration for Hispanic women (O/E = 1.08, P = 0.4) and NHW women (O/E = 0.98, P = 0.2). For Hispanic women, relative risks for number of breast biopsies (1.71 vs. 1.27, P = 0.03) and age at first birth (0.97 vs. 1.24, P = 0.02) differed between the WHI and BCRAT. The AUC was higher for Hispanic women than NHW women (0.63 vs. 0.58, P = 0.03). Updating the BCRAT with contemporaneous breast cancer incidence rates improved calibration in the WHI. The modest discriminatory accuracy of the BCRAT for Hispanic women might improve by using risk factor relative risks specific to Hispanic women.

Health disparities; Breast cancer; Women; Cancer rates; Racial factors; Risk factors; Author Keywords: Hispanic; Breast cancer; Risk prediction; Risk assessment; BCRAT

M. P. Banegas, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, P.O. Box 19024, M3-B232, Seattle, WA 98109, USA

BCTRD6

20120201

Journal Article

mbanegas@fhcrc.org

Grant

2012

Grant-Number-T42-OH-008433

1

0167-6806

Breast Cancer Research and Treatment

WA; AZ; MD; NY; CA

University of Washington