Personalized estimates of breast cancer risk in clinical practice and public health.
Personalized estimates of breast cancer risk in clinical practice and public health.
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DOI：
10.1002/sim.4187
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发表时间：
2011-05-10
影响因子：
2
通讯作者：
Gail, Mitchell H.
中科院分区：
文献类型：
--
作者：
Gail, Mitchell H.
关键词：
本文定义了绝对风险和它的一些属性，并介绍了在乳腺癌咨询和预防中的应用。对于咨询，绝对风险的估计提供了有用的观点，并可用于需要权衡风险和收益的管理决策，例如是否服用他莫昔芬预防乳腺癌。绝对风险模型还可用于设计预防乳腺癌的干预试验，以及评估减少与乳腺癌相关的暴露可能导致的疾病绝对风险的潜在降低。在这些应用中，重要的是风险模型要得到很好的校准，即它准确地预测在人口的各个子集中将发展乳腺癌的妇女人数。还需要绝对风险模型来实施“高风险”预防战略，确定人口中的高风险子集，并将干预工作集中在该子集上。高风险策略的局限性进行了讨论，包括需要高歧视的准确性风险模型，并需要毒性较小的干预措施，可以降低风险阈值以上的干预提供了净效益。我还讨论了潜在的使用风险模型在成本限制下分配预防资源。在这种应用中，除了良好的校准之外，风险模型的高判别准确性是可取的，并且与干预相比，风险评估不应昂贵。
This paper defines absolute risk and some of its properties, and presents applications in breast cancer counseling and prevention. For counseling, estimates of absolute risk give useful perspective and can be used in management decisions that require weighing risks and benefits, such as whether or not to take tamoxifen to prevent breast cancer. Absolute risk models are also useful in designing intervention trials to prevent breast cancer and in assessing the potential reductions in absolute risk of disease that might result from reducing exposures that are associated with breast cancer. In these applications, it is important that the risk model be well calibrated, namely that it accurately predict the numbers of women who will develop breast cancer in various subsets of the population. Absolute risk models are also needed to implement a “high risk” prevention strategy that identifies a high risk subset of the population and focuses intervention efforts on that subset. The limitations of the high risk strategy are discussed, including the need for risk models with high discriminatory accuracy, and the need for less toxic interventions that can reduce the threshold of risk above which the intervention provides a net benefit. I also discuss the potential use of risk models in allocating prevention resources under cost constraints. High discriminatory accuracy of the risk model, in addition to good calibration, is desirable in this application, and the risk assessment should not be expensive in comparison with the intervention.
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影响因子：
37.8
作者：
Cook, Nancy R.
通讯作者：
Cook, Nancy R.
影响因子：
8.8
作者：
Antoniou, A. C.;Cunningham, A. P.;Peto, J.;Evans, D. G.;Lalloo, F.;Narod, S. A.;Risch, H. A.;Eyfjord, J. E.;Hopper, J. L.;Southey, M. C.;Olsson, H.;Johannsson, O.;Borg, A.;Passini, B.;Radice, P.;Manoukian, S.;Eccles, D. M.;Tang, N.;Olah, E.;Anton-Culver, H.;Warner, E.;Lubinski, J.;Gronwald, J.;Gorski, B.;Tryggvadottir, L.;Syrjakoski, K.;Kallioniemi, O-P;Eerola, H.;Nevanlinna, H.;Pharoah, P. D. P.;Easton, D. F.
通讯作者：
Easton, D. F.
DOI：
10.1111/j.1467-985x.2009.00592.x
发表时间：
2009-01-01
影响因子：
2
作者：
Baker, Stuart G.;Cook, Nancy R.;Kramer, Barnett S.
通讯作者：
Kramer, Barnett S.
DOI：
10.1093/jnci/djj332
发表时间：
2006-09-06
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
Chen, Jinbo;Pee, David;Gail, Mitchell H.
通讯作者：
Gail, Mitchell H.
影响因子：
45.3
作者：
Berry, DA;Iversen, ES;Parmigiani, G
通讯作者：
Parmigiani, G