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Randomized Controlled Trial
. 2009 Apr;18(4):1084-91.
doi: 10.1158/1055-9965.EPI-08-1090. Epub 2009 Mar 31.

Performance of prediction models for BRCA mutation carriage in three racial/ethnic groups: findings from the Northern California Breast Cancer Family Registry

Allison W Kurian  1 , Gail D Gong, Esther M John, Alexander Miron, Anna Felberg, Amanda I Phipps, Dee W West, Alice S Whittemore
Affiliations
Randomized Controlled Trial

Performance of prediction models for BRCA mutation carriage in three racial/ethnic groups: findings from the Northern California Breast Cancer Family Registry

Allison W Kurian et al. Cancer Epidemiol Biomarkers Prev. 2009 Apr.

Abstract

Purpose: Patients with early-onset breast and/or ovarian cancer frequently wish to know if they inherited a mutation in one of the cancer susceptibility genes, BRCA1 or BRCA2. Accurate carrier prediction models are needed to target costly testing. Two widely used models, BRCAPRO and BOADICEA, were developed using data from non-Hispanic Whites (NHW), but their accuracies have not been evaluated in other racial/ethnic populations.

Methods: We evaluated the BRCAPRO and BOADICEA models in a population-based series of African American, Hispanic, and NHW breast cancer patients tested for BRCA1 and BRCA2 mutations. We assessed model calibration by evaluating observed versus predicted mutations and attribute diagrams, and model discrimination using areas under the receiver operating characteristic curves.

Results: Both models were well-calibrated within each racial/ethnic group, with some exceptions. BOADICEA overpredicted mutations in African Americans and older NHWs, and BRCAPRO underpredicted in Hispanics. In all racial/ethnic groups, the models overpredicted in cases whose personal and family histories indicated >80% probability of carriage. The two models showed similar discrimination in each racial/ethnic group, discriminating least well in Hispanics. For example, BRCAPRO's areas under the receiver operating characteristic curves were 83% (95% confidence interval, 63-93%) for NHWs, compared with 74% (59-85%) for African Americans and 58% (45-70%) for Hispanics.

Conclusions: The poor performance of the model for Hispanics may be due to model misspecification in this racial/ethnic group. However, it may also reflect racial/ethnic differences in the distributions of personal and family histories among breast cancer cases in the Northern California population.

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Figures

Fig. 1
Fig. 1
Flow Chart of Patient Screening, Sampling, and BRCA Mutation Testing a Breast cancer patients whose cancers are likely to be hereditary. b All other screened breast cancer patients.
Fig. 2
Fig. 2
Attribute Diagram (BRCAPRO Model Score versus BRCA Mutation Frequency) for African American, Hispanic and Non-Ashkenazi Jewish Non-Hispanic White (NHW non-AJ) Patients
See this image and copyright information in PMC

References

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