In the United States, Black women are more likely to have breast cancer at earlier ages and with a worse prognosis than white women. Despite this, there is a critical gap in breast cancer risk prediction models for Black women. Breast cancer risk prediction tools are used by clinicians to identify women at higher-than-average risk of breast cancer for early or more frequent screening by mammography and other modalities. But until now, there's been a lack of prediction tools tailored to Black women.
That's finally poised to change. Researchers at Boston University's School of Public Health and Slone Epidemiology Center have developed and evaluated a risk prediction model for breast cancer in Black women, suitable for use in primary care settings in the United States. The researchers described and evaluated the model in a recent report published in the Journal of Clinical Oncology.
"Because US Black women have a disproportionately high rate of breast cancer deaths, improvement in early detection of breast cancer in this population is critical, especially in young Black women who have not yet reached the ages at which mammographic screening is typically begun," says study corresponding author Julie Palmer, a BU SPH professor of epidemiology, director of BU's Slone Epidemiology Center, and the Karin Grunebaum Professor in Cancer Research at the BU School of Medicine.
Palmer and colleagues used epidemiologic data from three case-control studies of Black women from various regions of the United States to build a new risk prediction model. They tested the model using 15 years of follow-up data from 51,798 participants in BU's Black Women's Health Study, and found that it was well-calibrated. Discriminatory accuracy, which reflects how well a model predicts risk for an individual woman, was similar to that of the most frequently used questionnaire-based breast cancer risk prediction models for white women-;and was most accurate for women under age 40.
The researchers say the online tool is simple to use through a website, and all the information required can be obtained from the women themselves with a few questions.
This new tool for personalized prediction of breast cancer risk in Black women can be easily used by primary care providers to guide screening recommendations and/or referral for genetic testing, particularly for young Black women, thus leading to earlier diagnosis and reduced mortality."
Julie Palmer, Study's Corresponding Author
Women can also use the tool themselves and input their own information to calculate their five-year breast cancer risk, says study senior author Ludovic Trinquart, a BU SPH adjunct associate professor of biostatistics and director of the Center for Clinical Trials at Tufts Medical Center.
"We believe that it's best to discuss breast cancer risk and screening with a healthcare provider, and our tool could help women have a part in shared decision-making," Trinquart says.
Palmer, J.R., et al. (2021) A Validated Risk Prediction Model for Breast Cancer in US Black Women. Journal of Clinical Oncology. doi.org/10.1200/JCO.21.01236.