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Should Age-Dependent Absolute Risk Thresholds Be Used for Risk Stratification in Risk-Stratified Breast Cancer Screening?

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dc.contributor.authorPashayan, Nora
dc.contributor.authorAntoniou, Antonis C
dc.contributor.authorLee, Andrew
dc.contributor.authorWolfson, Michael
dc.contributor.authorChiquette, Jocelyne
dc.contributor.authorEloy, Laurence
dc.contributor.authorEisen, Andrea
dc.contributor.authorStockley, Tracy L
dc.contributor.authorNabi, Hermann
dc.contributor.authorBrooks, Jennifer D
dc.contributor.authorDorval, Michel
dc.contributor.authorEaston, Douglas F
dc.contributor.authorKnoppers, Bartha Maria
dc.contributor.authorChiarelli, Anna M
dc.contributor.authorSimard, Jacques
dc.contributor.orcidPashayan, Nora [0000-0003-0843-2468]
dc.contributor.orcidAntoniou, Antonis C [0000-0001-9223-3116]
dc.contributor.orcidStockley, Tracy L [0000-0002-4476-9722]
dc.contributor.orcidBrooks, Jennifer D [0000-0001-7574-4256]
dc.contributor.orcidDorval, Michel [0000-0002-3207-8211]
dc.date.accessioned2021-10-30T01:13:15Z
dc.date.available2021-10-30T01:13:15Z
dc.date.issued2021-09-15
dc.date.updated2021-10-30T01:13:14Z
dc.description.abstractIn 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.
dc.identifier.doi10.17863/CAM.77538
dc.identifier.issn2075-4426
dc.identifier.otherPMC8469877
dc.identifier.other34575693
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/330094
dc.languageeng
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.sourceessn: 2075-4426
dc.sourcenlmid: 101602269
dc.subjectMisclassification
dc.subjectAbsolute Risk
dc.subjectRisk-stratified Screening
dc.subjectRisk Threshold
dc.subjectRemaining Lifetime Risk
dc.titleShould Age-Dependent Absolute Risk Thresholds Be Used for Risk Stratification in Risk-Stratified Breast Cancer Screening?
dc.typeArticle
prism.issueIdentifier9
prism.publicationNameJournal of personalized medicine
prism.volume11
pubs.funder-project-idGenome Canada (13529)
pubs.funder-project-idCIHR (155865)
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.3390/jpm11090916

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