Evaluating the performance of the BOADICEA model in predicting 10-year breast cancer risks in UK Biobank
Menée à partir de données de la base "UK biobank" portant sur 217 885 femmes âgées de 40 à 70 ans, cette étude évalue la performance d'un modèle, basé sur les antécédents familiaux de cancer, des facteurs de risque identifiés par questionnaire, la présence de variants pathogènes et un score de risque polygénique, pour prédire le risque de cancer du sein à 10 ans (6 838 cas)
Background : The BOADICEA model predicts breast cancer risk using cancer family history, epidemiological and genetic data. We evaluated its validity in a large prospective cohort.
Methods : We assessed model calibration, discrimination and risk classification ability in 217,885 women (6,838 incident breast cancers) aged 40-70 years old of self-reported White ethnicity with no previous cancer from the UK Biobank. Age-specific risk classification was assessed using relative risk (RR) thresholds equivalent to the absolute lifetime risk categories of < 17%, 17-30% and
≥
30%, recommended by the National Institute for Health and Care Excellence guidelines. We predicted 10-year risks using BOADICEA v.6 considering cancer family history, questionnaire-based risk factors, a 313-SNP polygenic score and pathogenic variants. Mammographic density data were not available.
Results : The PRS was the most discriminative risk factor (AUC=0.65). Discrimination was highest when considering all risk factors (AUC=0.66). The model was well calibrated overall (E/O=0.99, 95%CI=0.97-1.02; calibration slope=0.99, 95%CI:0.99-1.00), and in deciles of predicted risks. Discrimination was similar in women younger and older than 50 years. There was some underprediction in women under age 50 (E/O=0.89, 95%CI=0.84-0.94; calibration slope=0.96, 95%CI:0.94-0.97), which was explained by the higher breast cancer incidence in UK Biobank than the UK population incidence in this age group. The model classified 87.2%, 11.4% and 1.4% of women in RR categories <1.6, 1.6-3.1 and
≥
3.1, identifying 25.6% of incident breast cancer cases in category RR
≥
1.6.
Conclusion : BOADICEA, implemented in CanRisk (www.canrisk.org), provides valid 10-year breast cancer risk which can facilitate risk-stratified screening and personalized breast cancer risk management.
Journal of the National Cancer Institute , article en libre accès, 2023