scholarly journals A streamlined model for use in clinical breast cancer risk assessment maintains predictive power and is further improved with inclusion of a polygenic risk score

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245375
Author(s):  
Richard Allman ◽  
Erika Spaeth ◽  
John Lai ◽  
Susan J. Gross ◽  
John L. Hopper
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
African American ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Risk Score ◽  
Clinical Risk Factors ◽  
Polygenic Risk Score ◽  
Gail Model ◽  
Clinical Risk

Five-year absolute breast cancer risk prediction models are required to comply with national guidelines regarding risk reduction regimens. Models including the Gail model are under-utilized in the general population for various reasons, including difficulty in accurately completing some clinical fields. The purpose of this study was to determine if a streamlined risk model could be designed without substantial loss in performance. Only the clinical risk factors that were easily answered by women will be retained and combined with an objective validated polygenic risk score (PRS) to ultimately improve overall compliance with professional recommendations. We first undertook a review of a series of 2,339 Caucasian, African American and Hispanic women from the USA who underwent clinical testing. We first used deidentified test request forms to identify the clinical risk factors that were best answered by women in a clinical setting and then compared the 5-year risks for the full model and the streamlined model in this clinical series. We used OPERA analysis on previously published case-control data from 11,924 Gail model samples to determine clinical risk factors to include in a streamlined model: first degree family history and age that could then be combined with the PRS. Next, to ensure that the addition of PRS to the streamlined model was indeed beneficial, we compared risk stratification using the Streamlined model with and without PRS for the existing case-control datasets comprising 1,313 cases and 10,611 controls of African-American (n = 7421), Caucasian (n = 1155) and Hispanic (n = 3348) women, using the area under the curve to determine model performance. The improvement in risk discrimination from adding the PRS risk score to the Streamlined model was 52%, 46% and 62% for African-American, Caucasian and Hispanic women, respectively, based on changes in log OPERA. There was no statistically significant difference in mean risk scores between the Gail model plus risk PRS compared to the Streamlined model plus PRS. This study demonstrates that validated PRS can be used to streamline a clinical test for primary care practice without diminishing test performance. Importantly, by eliminating risk factors that women find hard to recall or that require obtaining medical records, this model may facilitate increased clinical adoption of 5-year risk breast cancer risk prediction test in keeping with national standards and guidelines for breast cancer risk reduction.

scholarly journals Breast cancer risk prediction using a clinical risk model and polygenic risk score

2016 ◽  
Vol 159 (3) ◽  
pp. 513-525 ◽  
Author(s):  
Yiwey Shieh ◽  
Donglei Hu ◽  
Lin Ma ◽  
Scott Huntsman ◽  
Charlotte C. Gard ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Risk Prediction ◽  
Risk Score ◽  
Risk Model ◽  
Polygenic Risk Score ◽  
Polygenic Risk ◽  
Clinical Risk

scholarly journals Associations of Breast Cancer Risk Prediction Tools With Tumor Characteristics and Metastasis

2016 ◽  
Vol 34 (3) ◽  
pp. 251-258 ◽  
Author(s):  
Johanna Holm ◽  
Jingmei Li ◽  
Hatef Darabi ◽  
Martin Eklund ◽  
Mikael Eriksson ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
High Risk ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Risk Score ◽  
Distant Metastasis ◽  
Multinomial Logistic Regression ◽  
Polygenic Risk Score ◽  
Low Grade

Purpose The association between established risk factors for breast cancer and subtypes or prognosis of the disease is not well known. We analyzed whether the Tyrer-Cuzick–predicted 10-year breast cancer risk score (TCRS), mammographic density (MD), and a 77-single nucleotide polymorphism polygenic risk score (PRS) were associated with breast cancer tumor prognosticators and risk of distant metastasis. Patients and Methods We used a case-only design in a population-based cohort of 5,500 Swedish patients with breast cancer. Logistic and multinomial logistic regression of outcomes, estrogen receptor (ER) status, lymph node involvement, tumor size, and grade was performed with TCRS, PRS, and percent MD as exposures. Cox proportional hazard models were used to estimate hazard ratios (HRs) of distant metastasis. Results Women at high risk for breast cancer based on PRS and/or TCRS were significantly more likely to be diagnosed with favorable prognosticators, such as ER-positive and low-grade tumors. In contrast, PRS weighted on ER-negative disease was associated with ER-negative tumors. When stratifying by age, the associations of TCRS with favorable prognosticators were restricted to women younger than age 50. Women scoring high in both TCRS and PRS had a lower risk of distant metastasis (HR, 0.69; 95% CI, 0.49 to 0.98). MD was not associated with any of the examined prognosticators. Conclusion Women at high risk for breast cancer based on genetic and lifestyle factors were significantly more likely to be diagnosed with breast cancers with a favorable prognosis. Better knowledge of subtype-specific risk factors could be vital for the success of prevention programs aimed at lowering mortality.

Abstract P1-09-04: Association between a breast cancer polygenic risk score and contralateral breast cancer risk

2019 ◽  
Author(s):  
I Kramer ◽  
MJ Hooning ◽  
N Mavaddat ◽  
S Canisius ◽  
R Keeman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Risk Score ◽  
Contralateral Breast Cancer ◽  
Contralateral Breast ◽  
Polygenic Risk Score ◽  
Polygenic Risk

scholarly journals Polygenic risk score for the prediction of breast cancer is related to lesser terminal duct lobular unit involution of the breast

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Clara Bodelon ◽  
Hannah Oh ◽  
Andriy Derkach ◽  
Joshua N. Sampson ◽  
Brian L. Sprague ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Risk Score ◽  
Polygenic Risk Score ◽  
Intermediate Step ◽  
Breast Cancers ◽  
Tissue Samples ◽  
Polygenic Risk ◽  
Age Related

Abstract Terminal duct lobular units (TDLUs) are the predominant anatomical structures where breast cancers originate. Having lesser degrees of age-related TDLU involution, measured as higher TDLUs counts or more epithelial TDLU substructures (acini), is related to increased breast cancer risk among women with benign breast disease (BBD). We evaluated whether a recently developed polygenic risk score (PRS) based on 313-common variants for breast cancer prediction is related to TDLU involution in the background, normal breast tissue, as this could provide mechanistic clues on the genetic predisposition to breast cancer. Among 1398 women without breast cancer, higher values of the PRS were significantly associated with higher TDLU counts (P = 0.004), but not with acini counts (P = 0.808), in histologically normal tissue samples from donors and diagnostic BBD biopsies. Mediation analysis indicated that TDLU counts may explain a modest proportion (≤10%) of the association of the 313-variant PRS with breast cancer risk. These findings suggest that TDLU involution might be an intermediate step in the association between common genetic variation and breast cancer risk.

scholarly journals The Discovery of Breast Cancer Risk Gene and Establishment of Prediction Model Based on Estrogen Metabolism Regulation

2020 ◽  
Author(s):  
Feng Zhao ◽  
Zhixiang Hao ◽  
Yanan Zhong ◽  
Yinxue Xu ◽  
Meng Guo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Prediction Model ◽  
Risk Prediction ◽  
Risk Score ◽  
Healthy Subjects ◽  
Estrogen Metabolism ◽  
Polygenic Risk Score ◽  
Polygenic Risk

Abstract Background In this study, we aim to uncover the relationship between estrogen levels and the genetic polymorphism of estrogen metabolism-related enzymes with breast cancer (BC) and establish a risk prediction model based on polygenic risk score. Methods Unrelated BC patients and healthy subjects were recruited for analysis of the estrogen levels and the single nucleotide polymorphisms (SNPs) of estrogen metabolism-related enzymes. The polygenic risk score (PRS) was used to explore the combined effect of multiple genes which was calculated using a Bayesian approach. The independent sample t test was used to evaluate the difference between PRS scores of BC and healthy subjects. Discriminatory accuracy of the models was compared using the area under the receiver operating characteristic curve (ROC). Results The estrogen homeostasis profile was disturbed in BC patients, with parent estrogens (E1, E2) and carcinogenic catechol estrogens (2/4-OHE1, 2-OHE2, 4-OHE2) significantly accumulated in the serum of BC patients. Then,we established PRS model to evaluate the role of multiple genes SNPs. The PRS model 1 (M1) was established from 6 GWAS-identified high risk genes SNPs. On the basis of M1, we added 7 estrogen metabolism enzyme genes SNPs to establish PRS model 2 (M2). The independent sample t test results show that there is no difference between BC and healthy subjects in M1 (P = 0.17), however, there is significant difference between BC and healthy subjects in M2 (P = 4.9*10− 5). The ROC curve results also show that the accuracy of M2 (AUC = 62.18%) in breast cancer risk identification was better than M1 (AUC = 54.56%). Conclusion Estrogens and the related metabolic enzymes gene polymorphisms are closely related to BC. The model constructed by adding estrogen metabolic enzyme genes SNPs has a good ability in breast cancer risk prediction, and the accuracy is greatly improved comparing PRS model only includes GWAS-identified genes SNPs.

scholarly journals Genetic Risk Score to Identify Risk of Venous Thromboembolism in Patients With Cardiometabolic Disease

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Nicholas A. Marston ◽  
Giorgio E.M. Melloni ◽  
Yared Gurmu ◽  
Marc P. Bonaca ◽  
Frederick K. Kamanu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Score ◽  
Genetic Risk ◽  
Genetic Risk Score ◽  
Risk Groups ◽  
Clinical Risk Factors ◽  
Cardiometabolic Disease ◽  
Polygenic Risk Score ◽  
Clinical Risk ◽  
History Of

Background: Venous thromboembolism (VTE) is a major cause of cardiovascular morbidity and mortality and has a known genetic contribution. We tested the performance of a genetic risk score for its ability to predict VTE in 3 cohorts of patients with cardiometabolic disease. Methods: We included patients from the FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Patients With Elevated Risk), PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin), and SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus) trials (history of a major atherosclerotic cardiovascular event, myocardial infarction, and diabetes, respectively) who consented for genetic testing and were not on baseline anticoagulation. We calculated a VTE genetic risk score based on 297 single nucleotide polymorphisms with established genome-wide significance. Patients were divided into tertiles of genetic risk. Cox proportional hazards models were used to calculate hazard ratios for VTE across genetic risk groups. The polygenic risk score was compared with available clinical risk factors (age, obesity, smoking, history of heart failure, and diabetes) and common monogenic mutations. Results: A total of 29 663 patients were included in the analysis with a median follow-up of 2.4 years, of whom 174 had a VTE event. There was a significantly increased gradient of risk across VTE genetic risk tertiles ( P -trend <0.0001). After adjustment for clinical risk factors, patients in the intermediate and high genetic risk groups had a 1.88-fold (95% CI, 1.23–2.89; P =0.004) and 2.70-fold (95% CI, 1.81–4.06; P <0.0001) higher risk of VTE compared with patients with low genetic risk. In a continuous model adjusted for clinical risk factors, each standard deviation increase in the genetic risk score was associated with a 47% (95% CI, 29–68) increased risk of VTE ( P <0.0001). Conclusions: In a broad spectrum of patients with cardiometabolic disease, a polygenic risk score is a strong, independent predictor of VTE after accounting for available clinical risk factors, identifying 1/3 of patients who have a risk of VTE comparable to that seen with established monogenic thrombophilia.

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