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Evaluating breast cancer risk projections for Hispanic women

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Abstract

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.

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Fig. 1

Abbreviations

BCRAT:

Breast Cancer Risk Assessment Tool

NHW:

Non-Hispanic white

SEER:

Surveillance, epidemiology, and end results

WHI:

Women’s Health Initiative

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Acknowledgments

This research was supported, in part, by the National Cancer Institute Biobehavioral Cancer Prevention and Control Training Program (grant number R25CA092408) at the University of Washington and the Intramural Research Program of the National Institutes of Health/National Cancer Institute. The Women’s Health Initiative (WHI) program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services through contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221. The authors thank the WHI investigators and staff for their dedication, and the study participants for making the program possible. A listing of WHI investigators can be found at http://www.whiscience.org/publications/WHI_investigators_shortlist.pdf.

Conflicts of interest

The authors have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. School of Public Health, Department of Health Services, University of Washington, Box 357660, Seattle, WA, 98195, USA

    Matthew P. Banegas & Beti Thompson

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

    Matthew P. Banegas, Andrea LaCroix & Beti Thompson

  3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, 6120 Executive Blvd., EPS MSC 7244, Bethesda, MD, 20892-7234, USA

    Mitchell H. Gail

  4. Arizona Cancer Center and Mel and Enid Zuckerman College of Public Health, University of Arizona, 1515 N Campbell Ave, Box 245024, Tucson, AZ, 85724, USA

    Maria Elena Martinez

  5. School of Public Health and Health Professions, Department of Social and Preventive Medicine, University at Buffalo, Farber Hall, Rm. 270, Buffalo, NY, 14214, USA

    Jean Wactawski-Wende

  6. Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA, 94538, USA

    Esther M. John

  7. Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA, USA

    Esther M. John

  8. School of Medicine, University of California Irvine, 264 Irvine Hall, 1001 Health Sciences Road, Mail Code 3950, Irvine, CA, 92697, USA

    F. Allan Hubbell

  9. School of Medicine, University of California, Davis, Lawrence J. Ellison Ambulatory Care Center, 4860 Y St., Suite 2500, Sacramento, CA, 95817, USA

    Shagufta Yasmeen

  10. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, 6120 Executive Blvd. Room 8014, EPS MSC 7244, Bethesda, MD, 20892-7234, USA

    Hormuzd A. Katki

Authors
  1. Matthew P. Banegas
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  2. Mitchell H. Gail
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  3. Andrea LaCroix
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  4. Beti Thompson
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  5. Maria Elena Martinez
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  6. Jean Wactawski-Wende
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  7. Esther M. John
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  8. F. Allan Hubbell
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  9. Shagufta Yasmeen
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  10. Hormuzd A. Katki
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Corresponding authors

Correspondence to Matthew P. Banegas or Hormuzd A. Katki.

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Banegas, M.P., Gail, M.H., LaCroix, A. et al. Evaluating breast cancer risk projections for Hispanic women. Breast Cancer Res Treat 132, 347–353 (2012). https://doi.org/10.1007/s10549-011-1900-9

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

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