海报库PosterKeep
PO.PS01.09 · 人群科学

美国乳腺癌风险评估工具在114,533名墨西哥女性中的校准：来自墨西哥教师队列的证据

Calibration of the US breast cancer risk assessment tool in 114,533 Mexican women: Evidence from the Mexican Teachers' Cohort

编号 7590 展板 10 时间 4/22 09:00–12:00 区域 Section 35 主讲 Liliana Gomez-Flores-Ramos, BS;MS;PhD
分会场 Risk Prediction Modeling, Screening, Early Detection, and Preneoplastic and Tumor Markers
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作者与单位 Authors & Affiliations

Liliana Gomez-Flores-Ramos1, Mario Arturo Aguilar2, Dalia Stern1, Adrian Cortes-Valencia2, Marion Brochier2, Ariadna Gutierrez2, Gabriela Torres-Mejia2, Salvador Zamora3, Pabel Miranda-Aguirre4, Patricia Perez-Escobedo5, Alejandro Mohar6, Ruth Pfeiffer7, Martin Lajous8

1Secihti, National Institute of Public Health of Mexico, Mexico City, Mexico,2National Institute of Public Health of Mexico, Mexico City, Mexico,3UNAM, Mexico City, Mexico,4ISSSTE, Mexico City, Mexico,5Direccion medica, ISSSTE, Mexico City, Mexico,6Instituto de Investigaciones Biomedicas, UNAM, Mexico City, Mexico,7National Cancer Institute, NIH, Bethesda, MD,8National Institute of Public Health, Harvard T.H. Chan School of Public Health,, Bethesda, MD

摘要 Abstract

中文摘要
背景：乳腺癌风险预测模型正越来越多地用于识别适合接受基于风险的筛查和化学预防的女性。美国乳腺癌风险评估工具（NCI-BCRAT/Gail）是一种广泛使用的模型，但其在墨西哥女性中的表现尚不明确。墨西哥教师队列（MTC）是墨西哥的一项前瞻性癌症队列，是一项独特的资源，可用于评估乳腺癌风险模型在这一研究不足的人群中的实用性。因此，我们在一个大型、多样化的墨西哥女性队列中评估了该模型的校准度和区分度。 方法：在114,533名年龄为25-80岁、无癌症的女性中，计算了从入组至2019年12月31日的绝对浸润性乳腺癌风险。缺失的模型预测因子被归入最低风险类别。我们采用预期与观察（E/O）比值及95%置信区间（95% CI），比较了总体以及按5岁年龄组和原住民族裔划分的预期病例数与观察病例数。区分度采用ROC曲线下面积（AUC）评估。我们量化了在患乳腺癌和未患乳腺癌的女性中，预测风险超过5年高风险阈值的女性比例。 结果：在平均11.2年的随访期内，我们在队列参与者中识别出1,490名浸润性乳腺癌女性。NCI-BCRAT/Gail模型预测2,115名女性将会患乳腺癌，得出的预期与观察（E/O）比值为1.40（95% CI 1.35-1.49）。高估在50-54岁年龄组中最为显著（E/O = 1.62；95% CI 1.41-1.87）。在原住民女性中，79名患乳腺癌，而预测患病者为135名（E/O = 1.71；95% CI 1.35-1.49），50-54岁年龄组的E/O比值为2.71（95% CI 1.29-5.86）。该模型的区分准确度为63%（95% CI，62%-65%）。然而，82%患乳腺癌的女性未达到5年高风险阈值。此外，7%的非病例其预测风险超过5年高风险阈值。另外，还将展示使用不同墨西哥乳腺癌发病率估计值和5年高风险阈值的结果。 结论：NCI-BCRAT/Gail模型高估了MTC中墨西哥女性的浸润性乳腺癌风险。高估在年长女性和原住民女性中尤为突出。若“照原样”使用该模型，大多数患乳腺癌的女性会被归类为平均风险。这些发现提示，NCI-BCRAT/Gail在该人群中临床应用之前应予以重新校准和验证。
查看英文原文 English abstract
Background: Breast cancer risk prediction models are increasingly used to identify women for risk-based screening and chemoprevention. The US Breast Cancer Risk Assessment Tool (NCI-BCRAT/Gail) is a widely used model, yet its performance in Mexican women is unknown. The Mexican Teachers' Cohort (MTC), a prospective cancer cohort in Mexico, is a unique resource that can be leveraged to assess the usefulness of breast cancer risk models in this understudied population. Thus, we evaluated calibration and discrimination of this model in a large, diverse cohort of Mexican women. Methods: Absolute invasive breast cancer risk was calculated from enrollment to December 31, 2019, in 114,533 cancer-free women aged 25-80 years. Missing model predictors were assigned to the lowest-risk category. We compared expected and observed cases overall and by 5-year age groups and Indigenous ethnicity using expected-to-observed (E/O) ratios with 95% confidence intervals (95% CI). Discrimination was assessed with the area under the ROC curve (AUC). We quantified the proportion of women with a predicted risk above the 5-year high-risk threshold among those who developed and those who did not develop breast cancer. Results: Over a mean follow-up period of 11.2 years, we identified 1,490 women with invasive breast cancer among cohort participants. The NCI-BCRAT/Gail model predicted that 2,115 women would develop breast cancer, leading to an expected-to-observed (E/O) ratio of 1.40 (95% CI 1.35-1.49). Overestimation was most pronounced in the 50-54 age group (E/O = 1.62; 95% CI 1.41-1.87). Among Indigenous women, 79 developed breast cancer compared to 135 women who were predicted to develop the disease (E/O = 1.71;95% CI 1.35-1.49), and for age 50-54 E/O ratio was 2.71 (95% CI 1.29-5.86). The model's discriminatory accuracy was 63% (95% CI, 62%-65%). Yet, 82% of women who developed breast cancer did not reach the 5-year high-risk threshold. Also, 7% of non-cases had a predicted risk above the 5-year high-risk threshold. Further, results using different breast cancer incidence estimates for Mexico and 5-year high-risk thresholds will also be presented. Conclusions. The NCI-BCRAT/Gail model overestimated invasive breast cancer risk in Mexican women from the MTC. Overestimation was particularly salient in older women and Indigenous women. Using this model “as is”, most women who developed breast cancer would have been classified as average risk. These findings suggest that the NCI-BCRAT/Gail should be recalibrated and validated before clinical use in this population.
利益披露 Disclosure
L. Gomez-Flores-Ramos, None.. M. A. Aguilar, None.. D. Stern, None.. A. Cortes-Valencia, None.. M. Brochier, None.. A. Gutierrez, None.. G. Torres-Mejia, None.. S. Zamora, None.. P. Miranda-Aguirre, None.. P. Perez-Escobedo, None.. A. Mohar, None.. R. Pfeiffer, None.. M. Lajous, None.

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