title: Predicting and communicating the risk of recurrence and death in women with early-stage breast cancer: a systematic review of risk prediction models.
abstract: BACKGROUND
  It is a challenge for oncologists to distinguish patients with breast cancer who can forego adjuvant systemic treatment without negatively affecting survival from those who cannot. Risk prediction models (RPMs) have been developed for this purpose. Oncologists seem to have embraced RPMs (particularly Adjuvant!) in clinical practice and often use them to communicate prognosis to patients. We performed a systematic review of published RPMs and provide an overview of the prognosticators incorporated and reported clinical validity. Subsequently, we selected the RPMs that are currently used in the clinic for a more in-depth assessment of clinical validity. Finally, we assessed lay comprehensibility of the reports generated by RPMs.
  
  
  METHODS
  Pubmed, EMBASE, and Web of Science were searched. Two reviewers independently selected relevant articles and extracted data. Agreement on article selection and data extraction was achieved in consensus meetings.
  
  
  RESULTS
  We identified RPMs based on clinical prognosticators (N = 6) and biomolecular features (N = 14). Generally predictions from RPMs seem to be accurate, except for patients ≤ 50 years or ≥ 75 years at diagnosis, in addition to Asian populations. RPM reports contain much medical jargon or technical details, which are seldom explained in lay terms.
  
  
  CONCLUSIONS
  The accuracy of RPMs' prognostic estimates is suboptimal in some patient subgroups. This urgently needs to be addressed. In their current format, RPM reports are not conducive to patient comprehension. Communicating survival probabilities using RPM might seem straightforward, but it is fraught with difficulties. If not done properly, it can backfire and confuse patients. Evidence to guide best communication practice is needed.
authors.affiliation: Ellen G. Engelhardt, Mirjam M. Garvelink, Jacobus J.M. van der Hoeven, Arwen H. Pieterse, and Anne M. Stiggelbout, Leiden University Medical Center, Leiden; and J. (Hanneke) C.J.M. de Haes and Ellen M. Smets, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Ellen G
authors.initials: EG
authors.lastname: Engelhardt
authors.forename: Mirjam M
authors.initials: MM
authors.lastname: Garvelink
authors.forename: J Hanneke C J M
authors.initials: JH
authors.lastname: de Haes
authors.forename: Jacobus J M
authors.initials: JJ
authors.lastname: van der Hoeven
authors.forename: Ellen M A
authors.initials: EM
authors.lastname: Smets
authors.forename: Arwen H
authors.initials: AH
authors.lastname: Pieterse
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stiggelbout
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006291:Health Policy; D006300:Health Services Misuse / Q000517:prevention & control; D006801:Humans; D015233:Models, Statistical; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control*; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D014342:Truth Disclosure; D035501:Uncertainty
chemical_list: D000970:Antineoplastic Agents