Abstract
Background
Most risk-based breast cancer prevention and screening strategies rely on estimated invasive breast cancer risk. A recently developed model from the Breast Cancer Surveillance Consortium (BCSC) identifies women at elevated advanced cancer risk (prognostic pathologic stage II or greater) despite undergoing regular mammography screening.
Objective
To describe the characteristics of women identified for risk-based interventions based on advanced versus invasive breast cancer risk.
Design
Cross-sectional study.
Participants
Women aged 40–74 years undergoing mammography screening in routine clinical practice at 165 radiology facilities participating in the BCSC.
Main Measures
Established BCSC risk models were used to calculate cumulative 6-year advanced breast cancer risk and BCSC 5-year invasive breast cancer risk, stratified by age, race and ethnicity, breast density, and body mass index.
Key Results
Among 756,971 included women, the Spearman correlation between advanced and invasive cancer risk scores was 0.75. 31.9% of women had intermediate/high (≥ 0.38%) advanced cancer risk and 32.5% had intermediate/high (≥ 1.67%) invasive cancer risk. 21.1% had intermediate/high risk in both models and 22.1% had intermediate/high risk in only one model. Thirty-five percent of women with intermediate/high invasive cancer risk had low/average advanced cancer risk, and 16% of women with low/average invasive cancer risk had intermediate/high advanced cancer risk. Among women with intermediate/high advanced cancer risk, 17.5% were age 40–49, 25.7% were Black, 69.7% had dense breasts, and 81.1% were overweight/obese. Among women with intermediate/high invasive breast cancer risk, 5.2% were age 40–49, 11.9% were Black, 56.5% had dense breasts, and 70.6% were overweight/obese.
Conclusions
There are substantial differences in the characteristics of women identified as having elevated risk based on the advanced versus invasive breast cancer risk models. The advanced cancer risk model is important for identifying women who are young, Black, overweight/obese, or have dense breasts at intermediate/higher advanced cancer risk for consideration of risk-based interventions.
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Topic
Clinical Practice, JGIM
Author Descriptions
Office of Health Promotion Research, Department of Surgery, University of Vermont Larner College of Medicine, Burlington, VT, USA
Brian L. Sprague PhD
Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT, USA
Brian L. Sprague PhD & Hannah Perry MD
University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA
Brian L. Sprague PhD & Hannah Perry MD
Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM, USA
Charlotte C. Gard PhD, MBA
Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
Shuai Chen PhD & Diana L. Miglioretti PhD
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
Jeffrey A. Tice MD
Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
Anna N. A. Tosteson ScD
Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
Christoph I. Lee MD, MS
Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA
Diana L. Miglioretti PhD
Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
Karla Kerlikowske MD
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
Karla Kerlikowske MD
General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, CA, USA
Karla Kerlikowske MD
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