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A step in the development of a new breast cancer risk assessment tool for Hispanic women


This research is relevant for:

Unhecked Breast cancer survivors

Unhecked Women under 45

Unhecked Women over 45

Unhecked Men with breast cancer

Unhecked Metastatic breast cancer

Unhecked Triple negative breast cancer

Unhecked Previvors

Unhecked BRCA mutation carriers

Unhecked ER/PR +

Unhecked Her2+ breast cancer

Checked Special populations: Hispanic women

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Current tools used to calculate breast cancer risk make their estimations based on data from non-Hispanic white women and may not accurately predict breast cancer risk in women of other races and ethnicities. With further testing, a new risk assessment tool developed specifically for Hispanic women could more accurately predict breast cancer risk in women who do not have mutations in BRCA or other genes associated with hereditary breast cancer. (02/07/17)


STUDY AT A GLANCE

This study is about:

A newly developed tool to estimate breast cancer risk is based on data that is specific to Hispanic women.

Why is this study important?

The current risk calculation tool used to predict the likelihood of breast cancer underestimates the risk in Hispanic women by 18%, most likely because it combines data from Hispanic women and non-Hispanic white women. Models based on data from other races and ethnicities are needed to provide more accurate risk estimates for non-white populations.

Study findings: 

  1. The researchers developed a new risk assessment tool (the Hispanic risk model) that only includes data from Hispanic women.

What does this mean for me?

Researchers of the current study have developed a new risk assessment tool to estimate the absolute risk of invasive breast cancer for Hispanic women. However, much more work needs to be done to evaluate the validity of this tool. Hispanic women should speak to their health care providers with any concerns they may have about their breast cancer risk. All women, regardless of their race or ethnicity, who have breast cancer before age 50, triple-negative breast cancer before age 60, or ovarian cancer at any age meet national guidelines for genetic testing for mutations in BRCA or other genes that increase cancer risk. Women who do not have cancer but who have a strong family history of breast or ovarian cancer should talk to their health care providers to see whether genetic counseling is right for them.

Questions to ask your health care provider:

  • What is my breast cancer risk?
  • Why don’t current risk assessment tools provide an accurate estimate of my breast cancer risk?
  • What preventive measures can I take to lower my breast cancer risk?
  • My family has a history of breast cancer before age 50; should I consider genetic testing?

IN DEPTH REVIEW OF RESEARCH

Study background:

The National Cancer Institute’s Breast Cancer Risk Assessment Tool (BCRAT) is currently used to predict breast cancer risk in women who do not have mutations in BRCA or other genes associated with hereditary breast cancer. However, for Hispanic women, the BCRAT develops estimates of invasive breast cancer risk by combining Hispanic age-specific incidence rates with relative risks from white women. A previous research study reported that BCRAT underestimates Hispanic women’s breast cancer risk by 18%.

Matthew Banegas and colleagues from Kaiser Permanente Northwest published work in the Journal of the National Cancer Institute describing their new breast cancer risk estimation tool developed specifically for Hispanic women.

Researchers of this study wanted to:

Develop a risk assessment tool for calculating breast cancer risk specifically for Hispanic women.

Population(s) looked at in the study:

The researchers used data from the following sources for their model:

The San Francisco Bay Area Breast Cancer Study (SFBCS) included Hispanic women, ages 35-79 who were diagnosed with a first primary invasive breast cancer between 1995 and 2002. The study included information from 1,086 women with invasive breast cancer (533 were US-born while 553 were foreign-born) and 1,411 control participants (464 were US-born while 947 were foreign-born).
The California Cancer Registry (CCR) and SEER program were used for additional incidence and mortality information.

The risk estimates from the researchers’ new model were compared to the estimates from the National Cancer Institute’s Breast Cancer Risk Assessment Tool (BCRAT).

Results

  1. The researchers developed the Hispanic Risk Model (HRM) to estimate breast cancer risk that only uses data from Hispanic women.
    • The risk factors incorporated in this model included age at first full-term pregnancy and family history of breast cancer in first-degree female relatives.
    • Breast cancer risk calculated by the HRM was lower than the risk calculated by the National Cancer Institute’s Breast Cancer Risk Assessment Tool (BCRAT) for Hispanic women who were born in the U.S., but it was higher for foreign-born Hispanic women.

Limitations:

The researchers’ risk tool only used data from Hispanic females residing in California, so it is unknown how the tool will perform with other populations. And while different Hispanic subgroups exist in the United States, including women with different countries of origin as well as different races, the researchers categorized all Hispanic women into one group.  Additionally, the San Francisco Bay Area Breast Cancer Study (SFBCS) group included only women who were 35-79 years old.

In addition, not all risk factors were accounted for in the researchers’ model, such as breast density and genetic variants.  Additional factors could refine the model so that it accurately predicts breast cancer risk in both Hispanic women born in the United States and those born overseas. Finally, the researchers wrote that “The HRM, like the BCRAT, should not be used for certain women. It will probably underestimate breast cancer risk in Hispanic women with a personal history of breast cancer…, in women carrying breast cancer-causing mutations, and in women who received therapeutic radiation doses to the breast at a young age, such as for treatment of Hodgkin’s lymphoma.”

Conclusions:

Researchers have developed a new risk assessment tool to calculate breast cancer risk in Hispanic women who do carry gene mutations associated with hereditary breast cancer. Like the currently used BCRAT model, this model looks at risk for invasive breast cancer (stages I-IV) and not ductal carcinoma in situ (DCIS or stage 0).  However, more work needs to be done to validate this new model. In the meantime, Hispanic women should discuss any concerns they have with their health care providers.

Posted 2/7/17

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References

Banegas MP, John EM, Slattery ML, et al. “Projecting Individualized Absolute Invasive Breast Cancer Risk in US Hispanic Women.” Journal of the National Cancer Institute (2017); 109(2).  

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