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. 2010 Aug 1;28(22):3591-6.
doi: 10.1200/JCO.2010.28.0784. Epub 2010 Jul 6.

Evaluation of the Tyrer-Cuzick (International Breast Cancer Intervention Study) model for breast cancer risk prediction in women with atypical hyperplasia

Judy C Boughey  1 , Lynn C Hartmann, Stephanie S Anderson, Amy C Degnim, Robert A Vierkant, Carol A Reynolds, Marlene H Frost, V Shane Pankratz
Affiliations

Evaluation of the Tyrer-Cuzick (International Breast Cancer Intervention Study) model for breast cancer risk prediction in women with atypical hyperplasia

Judy C Boughey et al. J Clin Oncol. .

Abstract

Purpose: Accurate breast cancer risk assessment is vital to personalize screening and risk reduction strategies. Women with atypical hyperplasia have a four-fold higher risk of breast cancer. We evaluated the performance of the Tyrer-Cuzick model, which was designed to predict 10-year risk of breast cancer development, in a well-defined cohort of women with atypia.

Patients and methods: The Mayo Benign Breast Disease cohort includes 9,376 women who had a benign breast biopsy between 1967 and 1991. Among those, 331 women with atypia were identified by our study pathologists. Risk factor data for the Tyrer-Cuzick model were collated for each woman and used to predict individual risk of developing invasive breast cancer within 10 years.

Results: Over a median follow-up of 14.6 years, 64 (19%) of the 331 women developed invasive breast cancer. In the first 10 years after biopsy, 31 women developed invasive breast cancer whereas the Tyrer-Cuzick model predicted 58.9. The observed-to-predicted ratio was 0.53 (95% CI, 0.37 to 0.75). The concordance statistic was 0.540, revealing that the Tyrer-Cuzick model did not accurately distinguish, on an individual level, between women who developed invasive breast cancer and those who did not.

Conclusion: The Tyrer-Cuzick model significantly overestimated risk of breast cancer for women with atypia, and individual risk estimates showed poor concordance between predicted risk and invasive breast cancer development. Thus, we cannot recommend the use of the Tyrer-Cuzick model to predict 10-year breast cancer risk in women with atypical hyperplasia.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Risk predictions from the Tyrer-Cuzick model for the women with atypical hyperplasia by 10-year breast cancer status.
Fig 2.
Fig 2.
Receiver operating characteristic curves for the 10-year risk predictions generated by the Tyrer-Cuzick and Gail models in women with atypical hyperplasia. A diagonal reference line is provided that corresponds to a concordance statistic of 0.5.
Fig 3.
Fig 3.
Cumulative risk of breast cancer after breast biopsy for women with atypical hyperplasia. The dotted lines indicate the upper and lower 95% point-wise confidence bands.
See this image and copyright information in PMC

References

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