Breast cancer risk assessment in 8,824 women attending a family history evaluation and screening programme


Accurate individualized breast cancer risk assessment is essential to provide risk–benefit analysis prior to initiating interventions designed to lower breast cancer risk and start surveillance. We have previously shown that a manual adaptation of Claus tables was as accurate as the Tyrer–Cuzick model and more accurate at predicting breast cancer than the Gail, Claus model and Ford models. Here we reassess the manual model with longer follow up and higher numbers of cancers. Calibration of the manual model was assessed using data from 8,824 women attending the family history evaluation and screening programme in Manchester UK, with a mean follow up of 9.71 years. After exclusion of 40 prevalent cancers, 406 incident breast cancers occurred, and 385.1 were predicted (O/E = 1.05, 95 % CI 0.95–1.16) using the manual model. Predictions were close to that of observed cancers in all risk categories and in all age groups, including women in their forties (O/E = 0.99, 95 % CI 0.83–1.16). Manual risk prediction with use of adjusted Claus tables and curves with modest adjustment for hormonal and reproductive factors was a well-calibrated approach to breast cancer risk estimation in a UK family history clinic.

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This article presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (Reference Number RP-PG-0707-10031: “Improvement in risk prediction, early detection and prevention of breast cancer”). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. We acknowledge the support of the Manchester Biomedical Research Centre and the Genesis Breast Cancer Prevention Appeal. We would like to thank the study radiologists: Prof. Caroline Boggis, Prof. Anil Jain, Dr. YY Lim, Dr. Emma Hurley, Dr. Soujanya Gadde and Dr. Mary Wilson; the breast physicians Dr. Sally Bundred and Dr. Nicky Barr; and the advanced radiographer practitioners Elizabeth Lord, Rita Borgen and Jill Johnson, for mammography reporting. This study was funded By NIHR as part of the FH-risk study.

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The authors declare no conflict of interest.

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Correspondence to D. Gareth R. Evans.

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Evans, D.G.R., Ingham, S., Dawe, S. et al. Breast cancer risk assessment in 8,824 women attending a family history evaluation and screening programme. Familial Cancer 13, 189–196 (2014).

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  • Breast cancer
  • Risk estimation
  • Prospective
  • Claus
  • Tyrer–Cuzick