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01-12-2021 | Breast Cancer | Research article

Development and external validation of a breast cancer absolute risk prediction model in Chinese population

Authors: Yuting Han, Jun Lv, Canqing Yu, Yu Guo, Zheng Bian, Yizhen Hu, Ling Yang, Yiping Chen, Huaidong Du, Fangyuan Zhao, Wanqing Wen, Xiao-Ou Shu, Yongbing Xiang, Yu-Tang Gao, Wei Zheng, Hong Guo, Peng Liang, Junshi Chen, Zhengming Chen, Dezheng Huo, Liming Li, on behalf of the China Kadoorie Biobank Collaborative Group

Published in: Breast Cancer Research | Issue 1/2021

Abstract

Backgrounds

In contrast to developed countries, breast cancer in China is characterized by a rapidly escalating incidence rate in the past two decades, lower survival rate, and vast geographic variation. However, there is no validated risk prediction model in China to aid early detection yet.

Methods

A large nationwide prospective cohort, China Kadoorie Biobank (CKB), was used to evaluate relative and attributable risks of invasive breast cancer. A total of 300,824 women free of any prior cancer were recruited during 2004–2008 and followed up to Dec 31, 2016. Cox models were used to identify breast cancer risk factors and build a relative risk model. Absolute risks were calculated by incorporating national age- and residence-specific breast cancer incidence and non-breast cancer mortality rates. We used an independent large prospective cohort, Shanghai Women’s Health Study (SWHS), with 73,203 women to externally validate the calibration and discriminating accuracy.

Results

During a median of 10.2 years of follow-up in the CKB, 2287 cases were observed. The final model included age, residence area, education, BMI, height, family history of overall cancer, parity, and age at menarche. The model was well-calibrated in both the CKB and the SWHS, yielding expected/observed (E/O) ratios of 1.01 (95% confidence interval (CI), 0.94–1.09) and 0.94 (95% CI, 0.89–0.99), respectively. After eliminating the effect of age and residence, the model maintained moderate but comparable discriminating accuracy compared with those of some previous externally validated models. The adjusted areas under the receiver operating curve (AUC) were 0.634 (95% CI, 0.608–0.661) and 0.585 (95% CI, 0.564–0.605) in the CKB and the SWHS, respectively.

Conclusions

Based only on non-laboratory predictors, our model has a good calibration and moderate discriminating capacity. The model may serve as a useful tool to raise individuals’ awareness and aid risk-stratified screening and prevention strategies.

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Title: Development and external validation of a breast cancer absolute risk prediction model in Chinese population
Authors: Yuting Han
Jun Lv
Canqing Yu
Yu Guo
Zheng Bian
Yizhen Hu
Ling Yang
Yiping Chen
Huaidong Du
Fangyuan Zhao
Wanqing Wen
Xiao-Ou Shu
Yongbing Xiang
Yu-Tang Gao
Wei Zheng
Hong Guo
Peng Liang
Junshi Chen
Zhengming Chen
Dezheng Huo
Liming Li
on behalf of the China Kadoorie Biobank Collaborative Group
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Breast Cancer
Breast Cancer
Published in: Breast Cancer Research / Issue 1/2021
Electronic ISSN: 1465-542X
DOI: https://doi.org/10.1186/s13058-021-01439-2

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