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SUMMARY:The Value for Medical and Public Health Decisions of Adding Single
  Nucleotide Polymorphism Data to a Model for Breast Cancer Risk - Mitch Ga
 il\, Division of Cancer Epidemiology and Genetics\, National Cancer Instit
 ute\, USA
DTSTART:20091103T143000Z
DTEND:20091103T153000Z
UID:TALK19545@talks.cam.ac.uk
CONTACT:Michael Sweeting
DESCRIPTION:Seven single nucleotide polymorphisms (SNPs) have recently bee
 n confirmed to be associated with breast cancer.  I assessed the value of 
 adding these SNPs to the Breast Cancer Risk Assessment Tool (BCRAT)\, whic
 h is based on ages at menarche and at first live birth\, family history of
  breast cancer\, and history of breast biopsy examinations. The model with
  these SNPs (BCRATplus7) had an area under the receiver operating characte
 ristic curve (AUC) of 0.632\, compared to 0.607 for BCRAT.  This improveme
 nt is less than from adding mammographic density to BCRAT.  I also assesse
 d how much BCRATplus7 reduced expected losses in deciding whether a woman 
 should take tamoxifen to prevent breast cancer and in deciding whether a w
 oman should have a mammogram.  In addition\, I examined whether BCRATplus7
  was more effective than BCRAT in allocating a scarce public health resour
 ce\, such as access to mammography\, based on ranking women on their breas
 t cancer risk and allocating the resource to those at highest risk.  In no
 ne of these applications did BCRATplus7 perform substantially better than 
 BCRAT.  A cross-classification of risk by the two models indicated that so
 me women would change risk categories\, depending on the risk threshold\, 
 if BCRATplus7 were used instead of BCRAT\, but it is not known if BCRATplu
 s7 is well calibrated.  These results were hardly changed if three additio
 nal very recently identified SNPs were added.  I conclude that the availab
 le SNPs do not improve the performance of models to estimate breast cancer
  risk enough to warrant their use outside the research setting.
LOCATION:Large Seminar Room\, 1st Floor\, Institute of Public Health\, Uni
 versity Forvie Site\, Robinson Way\, Cambridge
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