Validation of Risk Assessment Models for Predicting the Incidence of Breast Cancer in Korean Women

Abstract

PurposeThe Gail model is one of the most widely used tools to assess the risk of breast cancer. However, it is known to overestimate breast cancer risk for Asian women. Here, we validate the Gail model and the Korean model using Korean data, and subsequently update and revalidate the Korean model using recent data.MethodsWe validated the modified Gail model (model 2), Asian American Gail model, and a previous Korean model using screening patient data collected between January 1999 and July 2004. The occurrence of breast cancer was confirmed by matching the resident registration number with data from the Korean Breast Cancer Registration Program. The expected-to-observed (E/O) ratio was used to validate the reliability of the program, and receiver operating characteristics curve analysis was used to evaluate the program's discriminatory power. There has been a rapid increase in the incidence of breast cancer in Korea, and we updated and revalidated the Korean model using incidence and mortality rate data from recent years.ResultsAmong 40,229 patients who were included in the validation, 161 patients were confirmed to have developed breast cancer within 5 years of screening. The E/O ratios and 95% confidence intervals (CI) were 2.46 (2.10-2.87) for the modified Gail model and 1.29 (1.11-1.51) for the Asian American Gail model. The E/O ratio and 95% CI for the Korean model was 0.50 (0.43-0.59). For the updated Korean model, the E/O ratio and 95% CI were 0.85 (0.73-1.00). In the discriminatory power, the area under curve and 95% CI of the modified Gail model, Asian American Gail model, Korean model and updated Korean model were 0.547 (0.500-0.594), 0.543 (0.495-0.590), 0.509 (0.463-0.556), and 0.558 (0.511-0.605), respectively.ConclusionThe updated Korean model shows a better performance than the other three models. It is hoped that this study can provide the basis for a clinical risk assessment program and a future prospective study of breast cancer prevention.

Assessment of the Gail Model in Estimating the Risk of Breast Cancer: Effect of Cancer Worry and Risk in Healthy Women

“…The Gail model might overestimate the risk of and development of breast cancer in other populations in which other races predominate (Novotny et al, 2006;Andreeva and Pokhrel 2013;Wang et al, 2018). However, utilization of the Gail model for Turkish population and other populations with white women predominance might provide more accurate estimations (Tice et al, 2005;Min et al, 2014;Wang et al, 2018). Accordingly, the five-year and life-time estimated risk for breast cancer was not higher in our study than different studies (Tice et al, 2005;Min et al, 2014;Khazaee-Pool et al, 2016, Wang et al, 2018.…”

“…However, utilization of the Gail model for Turkish population and other populations with white women predominance might provide more accurate estimations (Tice et al, 2005;Min et al, 2014;Wang et al, 2018). Accordingly, the five-year and life-time estimated risk for breast cancer was not higher in our study than different studies (Tice et al, 2005;Min et al, 2014;Khazaee-Pool et al, 2016, Wang et al, 2018. Unfortunately, the Gail model for breast cancer risk prediction of consanguineous marriages for fist degree and second-degree relatives is not included as a risk factor.…”

Epidemiology and survival outcome of breast cancer in a nationwide study

“…The Gail model was used widely since then but it is known to overestimate breast cancer risk for Asian women [5]. The updated Korean model proposed by Min et al in 2014 [6], including risk factors of age, body mass index, menopause status, breast feeding, family history, previous breast test and age at first delivery, showed a better performance than the other models for Asian women.…”

Breast Cancer Risk Assessment and Gail Model among Chinese Women

“…A recent Korean study showed a 50% underestimation of breast cancer risk among Korean women based on the modified Korean risk model developed using risk factors from a Korean case-control study and the incidence and mortality in Korea. For a more accurate prediction model, clinical information may not be adequate; biochemical data, such as estrogen level, mammographic density and molecular markers may need to be included to assure great discriminatory power [19].…”

“…The Gail Model has been widely used to assess women's risk of getting breast cancer; nevertheless, data using this model on women outside of Europe and North America are limited. The modified Gail score that was tailored to women of Asian descent as well as risk predictions scores were developed for Singapore and Korean women [16][17][18][19] while the application of Gail model in China is relatively scarce.…”