We examined whether a breast cancer risk prediction model other than the Gail et al. model performs better at discriminating between women who will and who will not develop the disease.
We applied the two published versions of the Rosner and Colditz log-incidence model of breast cancer, developed on data from the Nurses' Health Study, to the estimation of 5-year risk for the period 1992 to 1997 in the same cohort. The first version contained reproductive factors only, and the second version contained a more extensive list of risk factors.
Both versions of the model fit well. The ratio of expected to observed numbers of cases (E/O) in the first version was 1.00 (95% confidence interval [CI] 0.93–1.07); for the extended version the E/O was 1.01 (95% CI 0.94–1.09). The age-adjusted concordance statistic was 0.57 for the first model version and 0.63 for the extended version.
The discriminatory accuracy of the two versions was modest, although the addition of the variables in the extended version meaningfully increased the discriminatory accuracy of risk prediction over that found with the more parsimonious model.
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- Projecting individualized probabilities of developing breast cancer for white females who are being examined annually.J Natl Cancer Inst. 1989; 81: 1879-1886
- Validation studies for models projecting the risk of invasive and total breast cancer incidence.J Natl Cancer Inst. 1999; 91: 1541-1548
- Validation of the Gail et al. model of breast cancer risk and implications for chemoprevention.J Natl Cancer Inst. 2001; 93: 358-366
- ‘Hormonal’ risk factors, ‘breast tissue age’ and the age-incidence of breast cancer.Nature. 1983; 303: 767-770
- Estrogens, progestogens, normal breast cell proliferation, and breast cancer risk.Epidemiol Rev. 1993; 15: 48-65
- Nurses' Health Study: log-incidence mathematical model of breast cancer incidence.J Natl Cancer Inst. 1996; 88: 359-364
- Cumulative risk of breast cancer to age 70 years according to risk factor status: data from the Nurses' Health Study.Am J Epidemiol. 2000; 152: 950-964
- How well do prediction equations predict? Using receiver operating characteristic curves and accuracy curves to compare validity and generalizability.Epidemiology. 1993; 4: 319-326
- How well can we predict coronary heart disease? Findings in the United Kingdom Heart Disease Prevention Project.BMJ. 1984; 288: 1409-1411
- When can a risk factor be used as a worthwhile screening test?.BMJ. 1999; 319: 1562-1565
Accepted: April 17, 2003
© 2003 Elsevier Inc. Published by Elsevier Inc. All rights reserved.