PROJECTING INDIVIDUALIZED PROBABILITIES OF DEVELOPING BREAST-CANCER FOR WHITE FEMALES WHO ARE BEING EXAMINED ANNUALLY
PROJECTING INDIVIDUALIZED PROBABILITIES OF DEVELOPING BREAST-CANCER FOR WHITE FEMALES WHO ARE BEING EXAMINED ANNUALLY
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DOI：
10.1093/jnci/81.24.1879
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发表时间：
1989-12-20
影响因子：
10.3
通讯作者：
MULVIHILL, JJ
中科院分区：
文献类型：
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作者：
GAIL, MH;BRINTON, LA;MULVIHILL, JJ
为了协助医疗咨询，我们提出了一种方法来估计具有特定年龄和危险因素的妇女在特定时间内患乳腺癌的机会。使用的危险因素是初潮年龄、首次活产年龄、以前的活组织检查次数和患有乳腺癌的一级亲属数量。根据乳腺癌检测示范项目（BCDDP）的病例对照数据，建立了这些因素不同组合的相对风险模型。该模型考虑到这样一个事实，即50岁或50岁以上的女性与以往乳腺活检相关的相对风险要小于年轻女性。因此，我们放宽了比例风险假设，允许50岁以下人群和50岁以上人群分别建立比例风险模型。基线年龄特异性危险率，即没有确定危险因素的患者的危险率，计算为观察到的年龄特异性复合危险率乘以数量1减去归因风险的乘积。我们根据相对风险和基线危险率的信息计算出个体化乳腺癌的概率。这些计算考虑了竞争风险和风险区间。我们的数据来自参加BCDDP并倾向于定期检查的妇女。由于这个原因，给出的风险预测可能是最可靠的咨询妇女谁计划每年检查一次。
To assist in medical counseling, we present a method to estimate the chance that a women with given age and risk factors will develop breast cancer over a specified interval. The risk factors used were age at menarche, age at first live birth, number of previous biopsies, and number of first-degree relatives with breast cancer. A model of relative risks for various combinations of these factors was developed from case-control data from the Breast Cancer Detection Demonstration Project (BCDDP). The model allowed for the fact that relative risks associated with previous breast biopsies were smaller for women aged 50 or more than for younger women. Thus, proportional hazards assumption was relaxed to allow separate proportional hazards models for those under age 50 and for those of age 50 or more. The baseline age-specific hazard rate, which is the rate for a patient without identified risk factors, is computed as the product of the observed age-specific composite hazard rate times the quantity 1 minus the attributable risk. We calculated individualized breast cancer probabilities from information on relative risks and the baseline hazard rate. These calculations take competing risks and the interval of risk into account. Our data were derived from women who participated in the BCDDP and who tended to return for periodic examinations. For this reason, the risk projections given are probably most reliable for counseling women who plan to be examined about once a year.