Breast cancer risk stratification for mammographic screening: A nation‐wide screening cohort of 24,431 women in Singapore

Abstract Background Breast cancer incidence is increasing in Asia. However, few women in Singapore attend routine mammography screening. We aim to identify women at high risk of breast cancer who will benefit most from regular screening using the Gail model and information from their first screen (r...

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Autores principales:	Peh Joo Ho, Fuh Yong Wong, Wen Yee Chay, Elaine Hsuen Lim, Zi Lin Lim, Kee Seng Chia, Mikael Hartman, Jingmei Li
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	breast cancer Gail model mammogram recall status mammographic density mammography screening Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/00cf441a739e4ee1900f5c727f1bc8ac
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spelling	oai:doaj.org-article:00cf441a739e4ee1900f5c727f1bc8ac2021-11-22T09:08:48ZBreast cancer risk stratification for mammographic screening: A nation‐wide screening cohort of 24,431 women in Singapore2045-763410.1002/cam4.4297https://doaj.org/article/00cf441a739e4ee1900f5c727f1bc8ac2021-11-01T00:00:00Zhttps://doi.org/10.1002/cam4.4297https://doaj.org/toc/2045-7634Abstract Background Breast cancer incidence is increasing in Asia. However, few women in Singapore attend routine mammography screening. We aim to identify women at high risk of breast cancer who will benefit most from regular screening using the Gail model and information from their first screen (recall status and mammographic density). Methods In 24,431 Asian women (50–69 years) who attended screening between 1994 and 1997, 117 developed breast cancer within 5 years of screening. Cox proportional hazard models were used to study the associations between risk classifiers (Gail model 5‐year absolute risk, recall status, mammographic density), and breast cancer occurrence. The efficacy of risk stratification was evaluated by considering sensitivity, specificity, and the proportion of cancers identified. Results Adjusting for information from first screen attenuated the hazard ratios (HR) associated with 5‐year absolute risk (continuous, unadjusted HR [95% confidence interval]: 2.3 [1.8–3.1], adjusted HR: 1.9 [1.4–2.6]), but improved the discriminatory ability of the model (unadjusted AUC: 0.615 [0.559–0.670], adjusted AUC: 0.703 [0.653–0.753]). The sensitivity and specificity of the adjusted model were 0.709 and 0.622, respectively. Thirty‐eight percent of all breast cancers were detected in 12% of the study population considered high risk (top five percentile of the Gail model 5‐year absolute risk [absolute risk ≥1.43%], were recalled, and/or mammographic density ≥50%). Conclusion The Gail model is able to stratify women based on their individual breast cancer risk in this population. Including information from the first screen can improve prediction in the 5 years after screening. Risk stratification has the potential to pick up more cancers.Peh Joo HoFuh Yong WongWen Yee ChayElaine Hsuen LimZi Lin LimKee Seng ChiaMikael HartmanJingmei LiWileyarticlebreast cancerGail modelmammogram recall statusmammographic densitymammography screeningNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENCancer Medicine, Vol 10, Iss 22, Pp 8182-8191 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	breast cancer Gail model mammogram recall status mammographic density mammography screening Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	breast cancer Gail model mammogram recall status mammographic density mammography screening Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Peh Joo Ho Fuh Yong Wong Wen Yee Chay Elaine Hsuen Lim Zi Lin Lim Kee Seng Chia Mikael Hartman Jingmei Li Breast cancer risk stratification for mammographic screening: A nation‐wide screening cohort of 24,431 women in Singapore
description	Abstract Background Breast cancer incidence is increasing in Asia. However, few women in Singapore attend routine mammography screening. We aim to identify women at high risk of breast cancer who will benefit most from regular screening using the Gail model and information from their first screen (recall status and mammographic density). Methods In 24,431 Asian women (50–69 years) who attended screening between 1994 and 1997, 117 developed breast cancer within 5 years of screening. Cox proportional hazard models were used to study the associations between risk classifiers (Gail model 5‐year absolute risk, recall status, mammographic density), and breast cancer occurrence. The efficacy of risk stratification was evaluated by considering sensitivity, specificity, and the proportion of cancers identified. Results Adjusting for information from first screen attenuated the hazard ratios (HR) associated with 5‐year absolute risk (continuous, unadjusted HR [95% confidence interval]: 2.3 [1.8–3.1], adjusted HR: 1.9 [1.4–2.6]), but improved the discriminatory ability of the model (unadjusted AUC: 0.615 [0.559–0.670], adjusted AUC: 0.703 [0.653–0.753]). The sensitivity and specificity of the adjusted model were 0.709 and 0.622, respectively. Thirty‐eight percent of all breast cancers were detected in 12% of the study population considered high risk (top five percentile of the Gail model 5‐year absolute risk [absolute risk ≥1.43%], were recalled, and/or mammographic density ≥50%). Conclusion The Gail model is able to stratify women based on their individual breast cancer risk in this population. Including information from the first screen can improve prediction in the 5 years after screening. Risk stratification has the potential to pick up more cancers.
format	article
author	Peh Joo Ho Fuh Yong Wong Wen Yee Chay Elaine Hsuen Lim Zi Lin Lim Kee Seng Chia Mikael Hartman Jingmei Li
author_facet	Peh Joo Ho Fuh Yong Wong Wen Yee Chay Elaine Hsuen Lim Zi Lin Lim Kee Seng Chia Mikael Hartman Jingmei Li
author_sort	Peh Joo Ho
title	Breast cancer risk stratification for mammographic screening: A nation‐wide screening cohort of 24,431 women in Singapore
title_short	Breast cancer risk stratification for mammographic screening: A nation‐wide screening cohort of 24,431 women in Singapore
title_full	Breast cancer risk stratification for mammographic screening: A nation‐wide screening cohort of 24,431 women in Singapore
title_fullStr	Breast cancer risk stratification for mammographic screening: A nation‐wide screening cohort of 24,431 women in Singapore
title_full_unstemmed	Breast cancer risk stratification for mammographic screening: A nation‐wide screening cohort of 24,431 women in Singapore
title_sort	breast cancer risk stratification for mammographic screening: a nation‐wide screening cohort of 24,431 women in singapore
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/00cf441a739e4ee1900f5c727f1bc8ac
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Breast cancer risk stratification for mammographic screening: A nation‐wide screening cohort of 24,431 women in Singapore

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