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New breast cancer model designed to predict risk in Hispanic women
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A new breast cancer model designed specifically for Hispanic women could help health care providers more accurately predict breast cancer risk in Hispanic patients, according to a study published in the Journal of the National Cancer Institute.
“Prior studies have shown that Hispanic women born in the United States have a higher breast cancer risk than Hispanic women who emigrate here from other countries,” Matthew P. Banegas, PhD, MD, researcher from the Kaiser Permanente Center for Health Research, said in a press release. “Our model includes data from U.S.– and foreign-born women, so providers will be able to more accurately predict risk based on where the woman was born.”
The NCI’s Breast Cancer Risk Assessment Tool (BCRAT) predicts invasive breast cancer risk in non-Hispanic white, African American, and Asian and Pacific Islander American women. In a previous study, BCRAT underestimated breast cancer risk by 18% for Hispanic women. The new model is the first to be based exclusively on data from Hispanic women and will become part of NCI’s online tool that helps providers calculate breast cancer risk.
Breast cancer is the most common cancer among Hispanic women. Further, Hispanics comprise nearly 17% of the total U.S. population.
“Hispanics are the largest racial/ethnic minority group in the United States, so it’s important that the NCI tool include information from these women in determining their risk score,” Banegas said. “Our model does that because it is based on data from Hispanic women and specifically tailored for them.”
To build the Hispanic risk model (HRM), researchers collected data from the San Francisco Bay Area Breast Cancer Study (SFBCS), a multi-ethnic population-based case-control study. The study included 1,086 Hispanic women diagnosed with breast cancer between 1995 and 2002 (533 born in the United States, 553 born outside the United States) and 1,411 Hispanic women without breast cancer (464 born in the United States, 947 born outside the United States).
Banegas and colleagues combined relative and attributable risks from SFBCS with nativity-specific Hispanic breast cancer incidence and mortality data from the California Cancer Registry and SEER program. The model estimates absolute invasive breast cancer risk separately for Hispanic women born in and outside the United States.
The HRM for U.S.–born Hispanic women includes age at first full-term pregnancy, biopsy for benign breast disease and family history of cancer, whereas the foreign-born HRM also includes age at first menstruation.
The HRM estimated lower risks than the BCRAT for U.S.–born Hispanic women, but higher risks in foreign-born women. The BCRAT had high higher risk estimates than the HRM among U.S.–born women in 76% of risk patterns for women aged 35 years, 55% for women aged 50 years, and 69% for women aged 70 years. For foreign-born women, absolute risks from BRCAT were higher than from the HRM for women aged 35 years in 61% of risk patterns, but lower in 66% for women aged 50 years and 70 years.
In an independent review using data from the Women’s Health Initiative, the HRM was well calibrated for American-born Hispanic women (OR = 1.07; 95% CI, 0.81-1.4), but seemed to overestimate risk in foreign-born Hispanic women (OR = 0.66; 95% CI, 0.41-1.07). The area under the curve was 0.56 (95% CI, 0.48-0.64) for U.S.–born women and 0.62 (95% CI, 0.48-0.76) for foreign-born women.
Researchers noted future studies are warranted that collect comprehensive information on breast cancer risk factors, genomic data and health outcomes across different populations of Hispanic women.
“We built the model using data from Hispanic women in California who are mostly of Mexican and Central American descent, so these are women for whim the model will be most accurate,” Banegas said. “As we collect more data on Hispanic women from other regions and countries we will be able to further refine the model.”- by Chuck Gormley
Disclosure: The Intramural Research Program of the NCI, National Institutes of Health, supported the study. Banegas reports no relevant financial disclosures.
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