title: Breast cancer risk assessment: positive predictive value of family history as a predictor of risk.
abstract: OBJECTIVE
  The aim of this study was to evaluate the practical usefulness of family history as a tool for breast cancer risk assessment.
  
  
  METHODS
  Women from the Raloxifene Use for The Heart trial (N = 10,048), which consisted of postmenopausal women with or at high risk for coronary artery disease, were included in this post hoc analysis. The breast cancer risk score at baseline was calculated using the National Cancer Institute's Breast Cancer Risk Assessment tool. The positive predictive value of family history as a predictor of risk was determined for several risk thresholds.
  
  
  RESULTS
  Almost all (99.6%) women with a family history of breast cancer are found to be at high risk using the National Cancer Institute's accepted cutoff point of at least 1.66%, and almost 98% of women with a family history of breast cancer belong to the high-risk group when the cutoff point for risk score is 2%.
  
  
  CONCLUSIONS
  Family history alone as a high-risk predictor is associated with a high positive predictive value at commonly used cutoff points based on the risk estimates from the traditional Gail model. Although more complex models of breast cancer risk should still be used as the standard for assessment, screening using family history seems to be a first step in beginning the discussion with women.
authors.affiliation: Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, MO 64108, USA. BGumAlley@earthlink.net
authors.forename: Roger P
authors.initials: RP
authors.lastname: Smith
authors.forename: Xiao
authors.initials: X
authors.lastname: Ni
authors.forename: David
authors.initials: D
authors.lastname: Muram
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008487:Medical History Taking / Q000706:statistics & numerical data; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment / Q000706:statistics & numerical data*; D012307:Risk Factors; D016387:Women's Health