Mara A Schonberg, Emily A Wolfson, A Heather Eliassen, Bernard A Rosner, Andrea Z LaCroix, Rebecca A Nelson, Rowan T Chlebowski, Long H Ngo
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引用次数: 0
Abstract
Purpose: To inform decision making around mammography-screening frequency and cessation, we previously used Fine-Gray competing-risk regression to develop and validate a model to estimate older women's 10-year risk of breast cancer and their competing risk of non-breast cancer (non-BC) death. Here, we aimed to understand the amount of incident breast cancer and non-BC death risk explained by our model among women ≥ 65y.
Methods: We included women ≥ 65y who completed the 2004 Nurses' Health Study questionnaire (NHS, n = 59,662) or who participated in the Women's Health Initiative-Extension Study (WHI-ES, n = 82,528). We calculated our model's full and risk factor-specific population attributable risk (PAR%) for incident breast cancer and non-BC death.
Results: Mean age of the NHS participants was 73.5y (SD 5.2); 3.1% were diagnosed with breast cancer and 26.1% experienced non-BC death within 10 years. Mean age of WHI-ES participants was 73.6y (SD 5.4); 4.2% were diagnosed with breast cancer and 17.7% experienced non-BC death within 10 years. The full-model PAR% for breast cancer was 58.8% (22.7-80.6) in NHS and 54.8% (24.8-75.2%) in WHI-ES. Modifiable risk factors explained approximately 1/3 of breast cancer risk; BMI ≥ 30 had a PAR% of 6.5% (3.1-9.9%) in NHS and 12.2% (8.5-16.0%) in WHI-ES. For non-BC death, the full-model PAR% was 94.2% (91.4-96.1%) in NHS and 86.2% (80.9-90.0%) in WHI-ES.
Conclusions: Our competing-risk model explained the majority of breast cancers and non-BC deaths in women ≥ 65y, and we identified risk factors (e.g., elevated BMI) that may be targeted to reduce the burden of breast cancer in older women.
目的:为了为乳房x光检查频率和戒烟的决策提供信息,我们之前使用了Fine-Gray竞争风险回归来开发和验证一个模型,以估计老年妇女10年乳腺癌风险及其非乳腺癌(non-BC)死亡的竞争风险。在这里,我们的目的是了解我们的模型解释的≥65岁女性中乳腺癌发生率和非bc死亡风险。方法:我们纳入了完成2004年护士健康研究问卷(NHS, n = 59,662)或参加妇女健康倡议-扩展研究(WHI-ES, n = 82,528)的≥65岁的妇女。我们计算了模型中发生乳腺癌和非bc死亡的全部和危险因素特异性人群归因风险(PAR%)。结果:NHS参与者的平均年龄为73.5岁(SD 5.2);3.1%的人被诊断为乳腺癌,26.1%的人在10年内经历了非bc死亡。WHI-ES参与者的平均年龄为73.6岁(SD 5.4);4.2%被诊断为乳腺癌,17.7%在10年内经历非bc死亡。在NHS中,乳腺癌的全模型PAR%为58.8%(22.7-80.6),在WHI-ES中为54.8%(24.8-75.2%)。可改变的风险因素解释了大约1/3的乳腺癌风险;BMI≥30在NHS中PAR%为6.5%(3.1-9.9%),在WHI-ES中PAR%为12.2%(8.5-16.0%)。对于非bc死亡,全模型PAR%在NHS为94.2%(91.4-96.1%),在WHI-ES为86.2%(80.9-90.0%)。结论:我们的竞争风险模型解释了65岁以上女性中大多数乳腺癌和非bc死亡,我们确定了可能减轻老年女性乳腺癌负担的危险因素(例如,BMI升高)。
期刊介绍:
Breast Cancer Research and Treatment provides the surgeon, radiotherapist, medical oncologist, endocrinologist, epidemiologist, immunologist or cell biologist investigating problems in breast cancer a single forum for communication. The journal creates a "market place" for breast cancer topics which cuts across all the usual lines of disciplines, providing a site for presenting pertinent investigations, and for discussing critical questions relevant to the entire field. It seeks to develop a new focus and new perspectives for all those concerned with breast cancer.