Breast Cancer Risk Assessment for Postmenopausal Women Age 55 or Older with Consideration of Competing Mortality Risks

Population: Postmenopausal women age 55 years and older (with no history of breast cancer or genetic mutations that increase their risk of breast cancer)

Outcomes: 5- and 10-year breast cancer risk, 10-year risk of non-breast cancer death, 10-year risk of breast cancer death

Scroll to the bottom for more detailed information.

Risk Calculator
2. Have any of her first-degree female relatives (mother, sister or daughter) been diagnosed with breast cancer?


4. What best describes the woman’s cigarette use?


5. Over the past 10 years, what is the highest amount of alcohol the woman drank on average per week1?



6. How old was the woman at menopause2?



7. Did the woman give birth to a child?


8. Did she ever use hormone replacement therapy for relief of menopausal symptoms or for prevention of disease (do not include vaginal estrogens)?






9. Has the woman had a screening mammogram in the past 2 years?

10. Has the woman ever had a breast biopsy?


11. Health characteristics
• Cancer (excluding minor skin cancers)

• Chronic kidney disease or is on dialysis

• Dementia

• Depression

• Diabetes (including pre-diabetes)

• Emphysema or COPD

• Heart attack

• Heart failure

• High blood pressure

• Hip fracture

• Parkinson’s disease

• Stroke or transient ischemic attack (TIA)

12. Does the woman’s health limit her in walking several blocks?


13. Does the woman’s health limit her in bathing or dressing herself?


14. What is the woman’s usual walking pace outdoor in miles per hour (mph)?




1A standard drink is about one bottle/can of beer, 1 glass of wine, or 1 cocktail.

2If she had both of her ovaries removed before she experienced menopause naturally, please report her age at the time of this surgery. If she had her uterus removed before menopause but not both of her ovaries, please report her age when she thinks she started menopause based on symptoms.



Information about the models

We created 2 competing-risk prediction models. One model estimates risk of breast cancer (within 5 and 10 years) with consideration of risk of non-breast cancer death. The other model estimates 10-year non-breast cancer death with consideration of risk of breast cancer death.

Breast cancer prediction model

  • The breast cancer prediction model was developed in 37,628 postmenopausal women age 55 and older from the Nurses' Health Study (NHS), with a 10-year follow-up starting in 2004 (mean age 70 years, 96% non-Hispanic white)
  • We excluded women with a history of invasive breast cancer and censored women with noninvasive breast cancer or other cancers at the time of diagnosis
  • The model was internally validated using NHS participants (N=18,980), and externally validated in the Black Women’s Health Study (BWHS, N=13,247, 0% non-Hispanic white), Women’s Health Initiative (WHI, N=82,634, 86% non-Hispanic white), and Multiethnic Cohort Study (MEC, N=39,206, 26% non-Hispanic white) cohorts.
  • Discrimination: The risk calculator correctly sorts patients who were diagnosed with breast cancer within 5 years 61% of the time (c-index 95% CI: 0.58-0.64), and within 10 years 60% of the time (c-index 95% CI: 0.58-0.62). (57% in BWHS, WHI and MEC).
  • Calibration: The model was well calibrated within all risk groups at 5 and 10 years.

Non-breast cancer death prediction model

  • The non-breast cancer death prediction model was developed in 48,102 postmenopausal women age 55 and older from the NHS, with a 10-year follow-up starting in 2004 (mean age 70 years, 96% white)
  • The model was internally validated using NHS participants (N=24,088), and externally validated in the BWHS (N=15,001, 0% non-Hispanic white), WHI (N=92,720, 86% non-Hispanic white), and MEC (N=47,973, 26% non-Hispanic white) cohorts.
  • Discrimination: The risk calculator correctly sorts patients who died of causes other than breast cancer within 10 years 79% of the time (c-index 95% CI: 0.78-0.80). (77% in BWHS, 76% in WHI and MEC).
  • Calibration: The model was well calibrated within all risk groups.

Citations:

  • Schonberg MA, Wolfson EA, Eliassen AH, Bertrand KA, Shvetsov YB, Rosner BA, Palmer JR, Ngo LH. A model for predicting both breast cancer risk and non-breast cancer death among women > 55 years old. Breast Cancer Res. 2023 Jan 24;25(1):8. doi: 10.1186/s13058-023-01605-8.
  • Wolfson EA, Schonberg MA, Eliassen AH, Bertrand KA, Shvetsov YB, Rosner BA, Palmer JR, LaCroix AZ, Chlebowski RT, Nelson RA, Ngo LH. Validating a Model for Predicting Breast Cancer and Non-Breast Cancer Death in Women Aged 55 and Older. J Natl Cancer Inst. 2023 Sep 7:djad188. doi: 10.1093/jnci/djad188.
DISCLAIMER

The information provided on ePrognosis is designed to complement, not replace, the relationship between a patient and his/her own medical providers. ePrognosis was created with the support of the Division of Geriatrics at the University of California San Francisco. However, its content is strictly the work of its authors and has no affiliation with any organization or institution. This web site does not accept advertisements. If you reproduce the material on the website please cite appropriately. For feedback and questions regarding the site please email Sei Lee, MD (sei.lee@ucsf.edu), Alex Smith, MD (aksmith@ucsf.edu) or Eric Widera, MD (eric.widera@ucsf.edu).