title: Development and validation of a lung cancer risk prediction model for African-Americans.
abstract: Because existing risk prediction models for lung cancer were developed in white populations, they may not be appropriate for predicting risk among African-Americans. Therefore, a need exists to construct and validate a risk prediction model for lung cancer that is specific to African-Americans. We analyzed data from 491 African-Americans with lung cancer and 497 matched African-American controls to identify specific risks and incorporate them into a multivariable risk model for lung cancer and estimate the 5-year absolute risk of lung cancer. We performed internal and external validations of the risk model using data on additional cases and controls from the same ongoing multiracial/ethnic lung cancer case-control study from which the model-building data were obtained as well as data from two different lung cancer studies in metropolitan Detroit, respectively. We also compared our African-American model with our previously developed risk prediction model for whites. The final risk model included smoking-related variables [smoking status, pack-years smoked, age at smoking cessation (former smokers), and number of years since smoking cessation (former smokers)], self-reported physician diagnoses of chronic obstructive pulmonary disease or hay fever, and exposures to asbestos or wood dusts. Our risk prediction model for African-Americans exhibited good discrimination [75% (95% confidence interval, 0.67-0.82)] for our internal data and moderate discrimination [63% (95% confidence interval, 0.57-0.69)] for the external data group, which is an improvement over the Spitz model for white subjects. Existing lung cancer prediction models may not be appropriate for predicting risk for African-Americans because (a) they were developed using white populations, (b) level of risk is different for risk factors that African-American share with whites, and (c) unique group-specific risk factors exist for African-Americans. This study developed and validated a risk prediction model for lung cancer that is specific to African-Americans and thus more precise in predicting their risks. These findings highlight the importance of conducting further ethnic-specific analyses of disease risk.
authors.affiliation: Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. cetzel@mdanderson.org
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Etzel
authors.forename: Sumesh
authors.initials: S
authors.lastname: Kachroo
authors.forename: Mei
authors.initials: M
authors.lastname: Liu
authors.forename: Anthony
authors.initials: A
authors.lastname: D'Amelio
authors.forename: Qiong
authors.initials: Q
authors.lastname: Dong
authors.forename: Michele L
authors.initials: ML
authors.lastname: Cote
authors.forename: Angela S
authors.initials: AS
authors.lastname: Wenzlaff
authors.forename: Waun Ki
authors.initials: WK
authors.lastname: Hong
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Greisinger
authors.forename: Ann G
authors.initials: AG
authors.lastname: Schwartz
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Spitz
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001249:Asthma / Q000150:complications / Q000453:epidemiology; D002277:Carcinoma / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000453:epidemiology; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology