A model for predicting both breast cancer risk and non-breast cancer death among women > 55 years old
Abstract Background Guidelines recommend shared decision making (SDM) for mammography screening for women ≥ 75 and not screening women with < 10-year life expectancy. High-quality SDM requires consideration of women’s breast cancer (BC) risk, life expectancy, and values but is hard to implement b...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-01-01
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| Series: | Breast Cancer Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13058-023-01605-8 |
| _version_ | 1811175648081739776 |
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| author | Mara A. Schonberg Emily A. Wolfson A. Heather Eliassen Kimberly A. Bertrand Yurii B. Shvetsov Bernard A. Rosner Julie R. Palmer Long H. Ngo |
| author_facet | Mara A. Schonberg Emily A. Wolfson A. Heather Eliassen Kimberly A. Bertrand Yurii B. Shvetsov Bernard A. Rosner Julie R. Palmer Long H. Ngo |
| author_sort | Mara A. Schonberg |
| collection | DOAJ |
| description | Abstract Background Guidelines recommend shared decision making (SDM) for mammography screening for women ≥ 75 and not screening women with < 10-year life expectancy. High-quality SDM requires consideration of women’s breast cancer (BC) risk, life expectancy, and values but is hard to implement because no models simultaneously estimate older women’s individualized BC risk and life expectancy. Methods Using competing risk regression and data from 83,330 women > 55 years who completed the 2004 Nurses’ Health Study (NHS) questionnaire, we developed (in 2/3 of the cohort, n = 55,533) a model to predict 10-year non-breast cancer (BC) death. We considered 60 mortality risk factors and used best-subsets regression, the Akaike information criterion, and c-index, to identify the best-fitting model. We examined model performance in the remaining 1/3 of the NHS cohort (n = 27,777) and among 17,380 Black Women’s Health Study (BWHS) participants, ≥ 55 years, who completed the 2009 questionnaire. We then included the identified mortality predictors in a previously developed competing risk BC prediction model and examined model performance for predicting BC risk. Results Mean age of NHS development cohort participants was 70.1 years (± 7.0); over 10 years, 3.1% developed BC, 0.3% died of BC, and 20.1% died of other causes; NHS validation cohort participants were similar. BWHS participants were younger (mean age 63.7 years [± 6.7]); over 10-years 3.1% developed BC, 0.4% died of BC, and 11.1% died of other causes. The final non-BC death prediction model included 21 variables (age; body mass index [BMI]; physical function [3 measures]; comorbidities [12]; alcohol; smoking; age at menopause; and mammography use). The final BC prediction model included age, BMI, alcohol and hormone use, family history, age at menopause, age at first birth/parity, and breast biopsy history. When risk factor regression coefficients were applied in the validation cohorts, the c-index for predicting 10-year non-BC death was 0.790 (0.784–0.796) in NHS and 0.768 (0.757–0.780) in BWHS; for predicting 5-year BC risk, the c-index was 0.612 (0.538–0.641) in NHS and 0.573 (0.536–0.611) in BWHS. Conclusions We developed and validated a novel competing-risk model that predicts 10-year non-BC death and 5-year BC risk. Model risk estimates may help inform SDM around mammography screening. |
| first_indexed | 2024-04-10T19:40:10Z |
| format | Article |
| id | doaj.art-b456074e3a264f62ba8a38342ccb3135 |
| institution | Directory Open Access Journal |
| issn | 1465-542X |
| language | English |
| last_indexed | 2024-04-10T19:40:10Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Breast Cancer Research |
| spelling | doaj.art-b456074e3a264f62ba8a38342ccb31352023-01-29T12:25:10ZengBMCBreast Cancer Research1465-542X2023-01-0125111710.1186/s13058-023-01605-8A model for predicting both breast cancer risk and non-breast cancer death among women > 55 years oldMara A. Schonberg0Emily A. Wolfson1A. Heather Eliassen2Kimberly A. Bertrand3Yurii B. Shvetsov4Bernard A. Rosner5Julie R. Palmer6Long H. Ngo7Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical CenterDivision of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical CenterDepartment of Epidemiology, Harvard School of Public HealthSlone Epidemiology Center, Boston University, Boston University School of MedicineUniversity of Hawaii Cancer Center, University of Hawaii at ManoaDepartment of Epidemiology, Harvard School of Public HealthSlone Epidemiology Center, Boston University, Boston University School of MedicineDivision of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical CenterAbstract Background Guidelines recommend shared decision making (SDM) for mammography screening for women ≥ 75 and not screening women with < 10-year life expectancy. High-quality SDM requires consideration of women’s breast cancer (BC) risk, life expectancy, and values but is hard to implement because no models simultaneously estimate older women’s individualized BC risk and life expectancy. Methods Using competing risk regression and data from 83,330 women > 55 years who completed the 2004 Nurses’ Health Study (NHS) questionnaire, we developed (in 2/3 of the cohort, n = 55,533) a model to predict 10-year non-breast cancer (BC) death. We considered 60 mortality risk factors and used best-subsets regression, the Akaike information criterion, and c-index, to identify the best-fitting model. We examined model performance in the remaining 1/3 of the NHS cohort (n = 27,777) and among 17,380 Black Women’s Health Study (BWHS) participants, ≥ 55 years, who completed the 2009 questionnaire. We then included the identified mortality predictors in a previously developed competing risk BC prediction model and examined model performance for predicting BC risk. Results Mean age of NHS development cohort participants was 70.1 years (± 7.0); over 10 years, 3.1% developed BC, 0.3% died of BC, and 20.1% died of other causes; NHS validation cohort participants were similar. BWHS participants were younger (mean age 63.7 years [± 6.7]); over 10-years 3.1% developed BC, 0.4% died of BC, and 11.1% died of other causes. The final non-BC death prediction model included 21 variables (age; body mass index [BMI]; physical function [3 measures]; comorbidities [12]; alcohol; smoking; age at menopause; and mammography use). The final BC prediction model included age, BMI, alcohol and hormone use, family history, age at menopause, age at first birth/parity, and breast biopsy history. When risk factor regression coefficients were applied in the validation cohorts, the c-index for predicting 10-year non-BC death was 0.790 (0.784–0.796) in NHS and 0.768 (0.757–0.780) in BWHS; for predicting 5-year BC risk, the c-index was 0.612 (0.538–0.641) in NHS and 0.573 (0.536–0.611) in BWHS. Conclusions We developed and validated a novel competing-risk model that predicts 10-year non-BC death and 5-year BC risk. Model risk estimates may help inform SDM around mammography screening.https://doi.org/10.1186/s13058-023-01605-8Mortality predictionBreast cancer predictionCompeting risks |
| spellingShingle | Mara A. Schonberg Emily A. Wolfson A. Heather Eliassen Kimberly A. Bertrand Yurii B. Shvetsov Bernard A. Rosner Julie R. Palmer Long H. Ngo A model for predicting both breast cancer risk and non-breast cancer death among women > 55 years old Breast Cancer Research Mortality prediction Breast cancer prediction Competing risks |
| title | A model for predicting both breast cancer risk and non-breast cancer death among women > 55 years old |
| title_full | A model for predicting both breast cancer risk and non-breast cancer death among women > 55 years old |
| title_fullStr | A model for predicting both breast cancer risk and non-breast cancer death among women > 55 years old |
| title_full_unstemmed | A model for predicting both breast cancer risk and non-breast cancer death among women > 55 years old |
| title_short | A model for predicting both breast cancer risk and non-breast cancer death among women > 55 years old |
| title_sort | model for predicting both breast cancer risk and non breast cancer death among women 55 years old |
| topic | Mortality prediction Breast cancer prediction Competing risks |
| url | https://doi.org/10.1186/s13058-023-01605-8 |
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