Contralateral Risk-Reducing Mastectomy in Young Breast Cancer Patients with and without Genetic Cancer Risk Assessment

Background: The Gail model is the most well-known tool for breast cancer risk assessment worldwide. Although it was validated in various Western populations, inconsistent results were reported from Asian populations. We used data from a large case-control study and evaluated the discriminatory accuracy of the Gail model for breast cancer risk assessment among the Iranian female population. Methods: We used data from 942 breast cancer patients and 975 healthy controls at the Cancer Institute of Iran, Tehran, Iran, in 2016. We refitted the Gail model to our case-control data (the IR-Gail model). We compared the discriminatory power of the IR-Gail with the original Gail model, using ROC curve analyses and estimation of the area under the ROC curve (AUC). Results: Except for the history of biopsies that showed an extremely high relative risk (OR=9.1), the observed ORs were similar to the estimates observed in Gail's study. Incidence rates of breast cancer were extremely lower in Iran than in the USA, leading to a lower average absolute risk among the Iranian population (2.78, ±SD 2.45). The AUC was significantly improved after refitting the model, but it remained modest (0.636 vs. 0.627, ΔAUC = 0.009, bootstrapped P=0.008). We reported that the cut-point of 1.67 suggested in the Gail study did not discriminate between breast cancer patients and controls among the Iranian female population. Conclusion: Although the coefficients from the local study improved the discriminatory accuracy of the model, it remained modest. Cohort studies are warranted to evaluate the validity of the model for Iranian women.

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Breast Cancer Risk Assessment and Primary Prevention Advice in Primary Care: A Systematic Review of Provider Attitudes and Routine Behaviours

Cancers ◽

10.3390/cancers13164150 ◽

2021 ◽

Vol 13 (16) ◽

pp. 4150

Author(s):

Sarah Bellhouse ◽

Rhiannon E. Hawkes ◽

Sacha J. Howell ◽

Louise Gorman ◽

David P. French

Keyword(s):

Breast Cancer ◽

Risk Assessment ◽

Primary Care ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Primary Care Providers ◽

Cancer Risk Assessment ◽

Care Providers ◽

Breast Cancer Risk Assessment ◽

Risk Reducing

Implementing risk-stratified breast cancer screening is being considered internationally. It has been suggested that primary care will need to take a role in delivering this service, including risk assessment and provision of primary prevention advice. This systematic review aimed to assess the acceptability of these tasks to primary care providers. Five databases were searched up to July–August 2020, yielding 29 eligible studies, of which 27 were narratively synthesised. The review was pre-registered (PROSPERO: CRD42020197676). Primary care providers report frequently collecting breast cancer family history information, but rarely using quantitative tools integrating additional risk factors. Primary care providers reported high levels of discomfort and low confidence with respect to risk-reducing medications although very few reported doubts about the evidence base underpinning their use. Insufficient education/training and perceived discomfort conducting both tasks were notable barriers. Primary care providers are more likely to accept an increased role in breast cancer risk assessment than advising on risk-reducing medications. To realise the benefits of risk-based screening and prevention at a population level, primary care will need to proactively assess breast cancer risk and advise on risk-reducing medications. To facilitate this, adaptations to infrastructure such as integrated tools are necessary in addition to provision of education.

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Association of the Differences in Average Glandular Dose with Breast Cancer Risk

BioMed Research International ◽

10.1155/2020/8943659 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Le Ma ◽

Yuxing Cai ◽

Xiaojia Lin ◽

Zilong He ◽

Hui Zeng ◽

...

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Cancer Patients ◽

Healthy Subjects ◽

Assessment Model ◽

Cancer Risk Assessment ◽

Breast Cancer Patients ◽

Average Glandular Dose ◽

Breast Cancer Risk Assessment

Objectives. To compare the differences in normalized average glandular dose (NAGD) between the breasts of healthy subjects and those of cancer patients and to determine if the NAGD difference is associated with breast cancer risk and improves breast cancer classification. Materials and Methods. Craniocaudal view and mediolateral view full-field digital mammography (FFDM) images were obtained from 1682 healthy subjects whose breasts were categorized as Breast Imaging-Reporting and Data System (BI-RADS) I or II and from 811 biopsy-confirmed unilateral breast cancer patients whose breasts on the contralateral side were category I or II. Both populations were randomized into training and test sets. Multivariate logistic regression analysis was used to build the breast cancer risk assessment model, and the area under the receiver operating characteristic curve ( A z ) was used to evaluate the model. Twenty-two breast cancer patients who were originally categorized as BI-RADS I or II for both breasts, but were diagnosed with unilateral biopsy-confirmed breast cancer subsequently, were included to validate the model. Results. The NAGD differences in both FFDM images between tumor-bearing breasts and the healthy breasts of patients were significantly higher than those in healthy subjects ( P < 0.001 ). The model with NAGD differences had a higher A z value than the model without NAGD differences. While there was no NAGD differences between originally healthy breasts of breast cancer patients, significant NAGD differences between now tumor-bearing breasts and the then previously healthy breasts were found in both FFDM images. Conclusions. NAGD differences between both breasts can be included in the breast cancer risk assessment model to evaluate breast cancer risk.

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