Study: A step in the development of a new breast cancer risk assessment tool for Hispanic women
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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.
- 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 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, at any age or ovarian cancer at any age meet national guidelines for genetic testing for mutations in 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.
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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).
IN DEPTH REVIEW OF RESEARCH
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 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 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).
- 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.
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 .”
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 ( or 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.
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The National Comprehensive Cancer Network has guidelines on who should undergo genetic counseling and testing. If you have been diagnosed with breast cancer, you should speak with a genetics expert about genetic testing if any of the following apply to you:
- You have a blood relative who has tested positive for an
- You have any of the following:
- Breast cancer at age 50 or younger
- Male breast cancer at any age
- Ovarian cancer at any age
- at any age
- Two separate breast cancer diagnoses
- Eastern European Jewish ancestry and breast cancer at any age
- Lobular breast cancer and a family history of diffuse gastric cancer
- For treatment decisions for people with breast cancer or people with early , breast cancer who are at high-risk for recurrence
- Testing of your tumor shows a mutation in a gene that is associated with
- You have one or more close family members who have had:
- Young-onset or rare cancers
- Breast cancer at age 50 or younger
- Male breast cancer, ovarian cancer, pancreatic cancer, or cancer at any age
- Two separate cancer diagnoses
- prostate cancer or cancer that is high-risk or very-high-risk group.
The American Society of Breast Cancer Surgeons (ASBrS) released guidelines in 2019 that recommend all women diagnosed with breast cancer have access to genetic testing for inherited mutations in breast cancer genes.
If you are uncertain whether you meet the guidelines above and you are interested in or considering genetic testing, you should speak with a cancer genetics expert.
- 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?
The following clinical research studies focus on addressing in cancer.
- NCT04336397: Stool to Improve Colorectal Cancer Screening Among Alaska Native People. The goal is to determine the acceptability of a stool test to detect colorectal cancer within the Alaska tribal healthcare system.
- NCT04476654: Improving Uptake of Genetic Cancer Risk Assessment in African American Women-Video. This study looks at the usefulness of intervention with a culturally-tailored video to improve uptake of genetic counseling in Black women who are at increased risk of .
- NCT04450264: Increasing African Immigrant Women's Participation in Breast Cancer Screening (AIBCS). The study will look at barriers and facilitators to breast cancer screening among African-born immigrants, and adapt and test the Witness Project breast cancer education program to address breast screening disparities in this population.
- NCT04854304: Abbreviate or FAST Breast for Supplemental Breast Cancer Screening for Black Women at Average Risk and Dense Breasts. This study is looking at how effectively a FAST breast can successfully detect breast cancer in Black women with dense breasts.
- NCT03640208: Educate, Assess Risk and Overcoming Barriers to Colorectal Screening Among African Americans. This research will study a community-based intervention to educate and overcome barriers to screening among African Americans who are 45 years or older with no personal or family history of colorectal cancer or inflammatory bowel disease.
- NCT04392050: A Community-Based Educational Intervention to Improve Colorectal Cancer Screening. This study will look at what makes it easy or difficult for underserved populations to have colorectal cancer screenings, with a focus on African American, Latinx and Asian people.
- NCT03550885: Diet Modulation of Bacterial Sulfur and Bile Acid Metabolism and Colon Cancer Risk. This effort will look at how bile secretion into the intestine selects for bacteria that produce tumor-promoting molecules in African Americans with an increased risk for colorectal cancer.
The following organizations offer peer support services for people with, or at high risk for breast cancer:
- FORCE peer support:
- Our Message Boards allow people to connect with others who share their situation. Once you register, you can post on the Diagnosed With Cancer board to connect with other people who have been diagnosed.
- Our Peer Navigation Program will match you with a volunteer who shares your mutation and situation.
- Connect online with our Private Facebook Group.
- Join our virtual and in-person support meetings.
- Other organizations that offer breast cancer support:
The following resources can help you locate a genetics expert near you or via telehealth.
Finding genetics experts
- The National Society of Genetic Counselor website has a search tool for finding a genetic counselor by specialty and location or via telehealth.
- InformedDNA is a network of board-certified genetic counselors providing this service by telephone. They can also help you find a qualified expert in your area for face-to-face genetic counseling if that is your preference.
- Gene-Screen is a third party genetic counseling group that can help educate, support and order testing for patients and their families.
- JScreen is a national program based out of Emory University that provides low-cost at-home genetic counseling and testing with financial assistance available.
- Grey Genetics provides access to genetic counselors who offer genetic counseling by telephone.
- The Genetic Support Foundation offers genetic counseling with board-certified genetic counselors.
- The American College of Medical Genetics website has a tool to find genetics clinics by location and specialty.
Other ways to find experts
- Register for the FORCE Message Boards and post on the Find a Specialist board to connect with other people who share your situation.
- The National Cancer Institute (NCI)-designated comprehensive cancer centers have genetic counselors who specialize in cancer.
- FORCE's toll-free helpline at: 866-288-RISK, ext. 704 will connect you with a volunteer board-certified genetic counselor who can help you find a genetics expert near you.
Who covered this study?
New breast cancer model developed for Hispanic women This article rates 3.5 out of 5 stars
New breast cancer model designed to predict risk in Hispanic women This article rates 3.5 out of 5 stars