Should Age-Dependent Absolute Risk Thresholds Be Used for Risk Stratification in Risk-Stratified Breast Cancer Screening?
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Authors
Lee, Andrew
Wolfson, Michael
Chiquette, Jocelyne
Eloy, Laurence
Eisen, Andrea
Nabi, Hermann
Easton, Douglas F
Knoppers, Bartha Maria
Chiarelli, Anna M
Simard, Jacques
Publication Date
2021-09-15Journal Title
Journal of personalized medicine
ISSN
2075-4426
Volume
11
Issue
9
Language
eng
Type
Article
This Version
VoR
Metadata
Show full item recordCitation
Pashayan, N., Antoniou, A. C., Lee, A., Wolfson, M., Chiquette, J., Eloy, L., Eisen, A., et al. (2021). Should Age-Dependent Absolute Risk Thresholds Be Used for Risk Stratification in Risk-Stratified Breast Cancer Screening?. Journal of personalized medicine, 11 (9) https://doi.org/10.3390/jpm11090916
Abstract
In risk-stratified cancer screening, multiple risk factors are incorporated into the risk assessment. An individual's estimated absolute cancer risk is linked to risk categories with tailored screening recommendations for each risk category. Absolute risk, expressed as either remaining lifetime risk or shorter-term (five- or ten-year) risk, is estimated from the age at assessment. These risk estimates vary by age; however, some clinical guidelines (e.g., enhanced breast cancer surveillance guidelines) and ongoing personalised breast screening trials, stratify women based on absolute risk thresholds that do not vary by age. We examine an alternative approach in which the risk thresholds used for risk stratification vary by age and consider the implications of using age-independent risk thresholds on risk stratification. We demonstrate that using an age-independent remaining lifetime risk threshold approach could identify high-risk younger women but would miss high-risk older women, whereas an age-independent 5-year or 10-year absolute risk threshold could miss high-risk younger women and classify lower-risk older women as high risk. With risk misclassification, women with an equivalent risk level would be offered a different screening plan. To mitigate these problems, age-dependent absolute risk thresholds should be used to inform risk stratification.
Keywords
Misclassification, Absolute Risk, Risk-stratified Screening, Risk Threshold, Remaining Lifetime Risk
Sponsorship
Genome Canada (13529)
CIHR (155865)
Identifiers
PMC8469877, 34575693
External DOI: https://doi.org/10.3390/jpm11090916
This record's URL: https://www.repository.cam.ac.uk/handle/1810/330094
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