Comparison of methods to assess onset of breast development in the LEGACY Girls Study: methodological considerations for studies of breast cancer

Abstract

BackgroundYounger age at onset of breast development, which has been declining in recent decades, is associated with increased breast cancer risk independent of age at menarche. Given the need to study the drivers of these trends, it is essential to validate methods to assess breast onset that can be used in large-scale studies when direct clinical assessment of breast onset is not feasible.MethodsBreast development is usually measured by Tanner stages (TSs), assessed either by physical examination or by mother’s report using a picture-based Sexual Maturation Scale (SMS). As an alternative, a mother-reported Pubertal Development Scale (PDS) without pictures has been used in some studies. We compared agreement of SMS and PDS with each other (n = 1022) and the accuracy of PDS with clinical TS as a gold standard for the subset of girls with this measure (n = 282) using the LEGACY cohort. We further compared prediction of breast onset using ROC curves and tested whether adding urinary estrone 1-glucuronide (E1G) improved the AUC.ResultsThe agreement of PDS with SMS was high (kappa = 0.80). The sensitivity of PDS vs clinical TS was 86.6%. The AUCs for PDS alone and SMS alone were 0.88 and 0.79, respectively. Including E1G concentrations improved the AUC for both methods (0.91 and 0.86 for PDS and SMS, respectively).ConclusionsThe PDS without pictures is a highly accurate, sensitive, and specific method for assessing breast onset, especially in settings where clinical TS is not feasible. In addition, it is comparable to SMS methods with pictures and thus easier to implement in large-scale studies, particularly phone-based interviews where pictures may not be available. Urinary E1G can improve accuracy over than PDS or SMS alone.Electronic supplementary materialThe online version of this article (10.1186/s13058-018-0943-9) contains supplementary material, which is available to authorized users.

Common Childhood Viruses and Pubertal Timing: The LEGACY Girls Study

“…Marshall and Tanner Staging (hereafter referred to as Tanner Staging (TS)) consists of 5 images ranging from no development (TS1) to full development (TS5), where TS2 is considered the beginning of pubertal development. Mother's report is the primary outcome method; we have previously shown that it is a validated measure compared with clinical measures of TS (32), and it was available for the whole cohort. We also used clinician-assessed breast development that was administered every 6 months at the New York and Utah LEGACY sites (details published previously (28)).…”

Urinary Androgens Provide Additional Evidence Related to Metabolism and Are Correlated With Serum Androgens in Girls

“…We also collected pubertal development data via guardian-reported Tanner stages but used PDS in this manuscript since we have previously shown that PDS correlates more with hormone concentrations than Tanner stage. To define menarche, guardians reported if their daughter had their first menses and, if so, recalled the age to the nearest half-year [ 32 , 33 ].…”

Immigrant generation status and its association with pubertal timing and tempo among Hispanic girls and boys

“…Children completed the Pubertal Development Scale (PDS), a validated self‐assessed questionnaire describing stages of pubertal development, which is more correlated with pubertal hormones and clinical exam than other picture‐based methods (Coleman & Coleman, 2002; Houghton et al, 2018; Petersen et al, 1988; Schmitz et al, 2004; Terry et al, 2016). The pubertal outcomes were thelarche (onset of breast development), pubarche (onset of pubic hair growth) and menarche (first menstrual period) in girls, and pubarche and voice change (development has begun) in boys.…”