Projecting individualized probabilities of developing bladder cancer in white individuals.
OBJECTIVE
There has been no risk assessment model for bladder cancer (BC). We developed the first model incorporating mutagen sensitivity and epidemiologic factors to predict BC risk.


METHODS
We used epidemiologic and genetic data from a large case-control study to build the models and constructed receiver operating characteristic curves. The area under the curve (AUC) was used to evaluate model discriminatory ability. We also projected absolute risk of developing BC by taking into account competing causes of death.


RESULTS
The study included 678 white BC patients and 678 controls. Significant risk factors in the epidemiologic model included pack-years smoked and exposures to diesel, aromatic amines, dry cleaning fluids, radioactive materials, and arsenic. This model yielded good discriminatory ability (AUC = 0.70; 95% CI, 0.67 to 0.73). When mutagen sensitivity data were incorporated, the AUC increased to 0.80 (95% CI, 0.72 to 0.82). The models showed excellent concordance in the internal validation. We also computed an easy to use ordinal risk score and provided examples for projecting absolute risk.


CONCLUSIONS
We have developed the first risk prediction model for BC. The enhanced model integrating the genetic factor exhibited excellent discriminatory ability. Our model only requires an individual to answer a few simple questions during a clinic visit to project individualized probability. This model may be used as a basis for developing a Web-based tool for BC risk assessment. Validation of our model in an external population is an essential next step towards practical use in the clinical setting.
Wu
Xifeng
X
Department of Epidemiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. xwu@mdanderson.org
Lin
Jie
J
Grossman
H Barton
HB
Huang
Maosheng
M
Gu
Jian
J
Etzel
Carol J
CJ
Amos
Christopher I
CI
Dinney
Colin P
CP
Spitz
Margaret R
MR
D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011336:Probability; D012372:ROC Curve; D018570:Risk Assessment; D013781:Texas / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology*; D044465:White People