title: Improved web-based calculators for predicting breast carcinoma outcomes.
abstract: We describe a set of web-based calculators, available at http://www.CancerMath.net , which estimate the risk of breast carcinoma death, the reduction in life expectancy, and the impact of various adjuvant treatment choices. The published SNAP method of the binary biological model of cancer metastasis uses information on tumor size, nodal status, and other prognostic factors to accurately estimate of breast cancer lethality at 15 years after diagnosis. By combining these 15-year lethality estimates with data on the breast cancer hazard function, breast cancer lethality can be estimated at each of the 15 years after diagnosis. A web-based calculator was then created to visualize the estimated lethality with and without a range of adjuvant therapy options at any of the 15 years after diagnosis, and enable conditional survival calculations. NIH population data was used to estimate non-breast-cancer chance of death. The accuracy of the calculators was tested against two large breast carcinoma datasets: 7,907 patients seen at two academic hospitals and 362,491 patients from the SEER national dataset. The calculators were found to be highly accurate and specific, as seen by their capacity for stratifying patients into groups differing by as little as a 2% risk of death, and accurately accounting for nodal status, histology, grade, age, and hormone receptor status. Our breast carcinoma calculators provide accurate and useful estimates of the risk of death, which can aid in analysis of the various adjuvant therapy options available to each patient.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. michaelj@helix.mgh.harvard.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Michaelson
authors.forename: L Leon
authors.initials: LL
authors.lastname: Chen
authors.forename: Devon
authors.initials: D
authors.lastname: Bush
authors.forename: Allan
authors.initials: A
authors.lastname: Fong
authors.forename: Barbara
authors.initials: B
authors.lastname: Smith
authors.forename: Jerry
authors.initials: J
authors.lastname: Younger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D020407:Internet; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014584:User-Computer Interface; D055815:Young Adult