title: Bias Correction Methods Explain Much of the Variation Seen in Breast Cancer Risks of BRCA1/2 Mutation Carriers.
abstract: OBJECTIVE
  Recommendations for treating patients who carry a BRCA1/2 gene are mainly based on cumulative lifetime risks (CLTRs) of breast cancer determined from retrospective cohorts. These risks vary widely (27% to 88%), and it is important to understand why. We analyzed the effects of methods of risk estimation and bias correction and of population factors on CLTRs in this retrospective clinical cohort of BRCA1/2 carriers.
  
  
  METHODS
  The following methods to estimate the breast cancer risk of BRCA1/2 carriers were identified from the literature: Kaplan-Meier, frailty, and modified segregation analyses with bias correction consisting of including or excluding index patients combined with including or excluding first-degree relatives (FDRs) or different conditional likelihoods. These were applied to clinical data of BRCA1/2 families derived from our family cancer clinic for whom a simulation was also performed to evaluate the methods. CLTRs and 95% CIs were estimated and compared with the reference CLTRs.
  
  
  RESULTS
  CLTRs ranged from 35% to 83% for BRCA1 and 41% to 86% for BRCA2 carriers at age 70 years width of 95% CIs: 10% to 35% and 13% to 46%, respectively). Relative bias varied from -38% to +16%. Bias correction with inclusion of index patients and untested FDRs gave the smallest bias: +2% (SD, 2%) in BRCA1 and +0.9% (SD, 3.6%) in BRCA2.
  
  
  CONCLUSIONS
  Much of the variation in breast cancer CLTRs in retrospective clinical BRCA1/2 cohorts is due to the bias-correction method, whereas a smaller part is due to population differences. Kaplan-Meier analyses with bias correction that includes index patients and a proportion of untested FDRs provide suitable CLTRs for carriers counseled in the clinic.
authors.affiliation: Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA. j.r.vos01@umcg.nl.
authors.forename: Janet R
authors.initials: JR
authors.lastname: Vos
authors.affiliation: Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Li
authors.initials: L
authors.lastname: Hsu
authors.affiliation: Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Brohet
authors.affiliation: Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Marian J E
authors.initials: MJ
authors.lastname: Mourits
authors.affiliation: Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Jakob
authors.initials: J
authors.lastname: de Vries
authors.affiliation: Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Malone
authors.affiliation: Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Oosterwijk
authors.affiliation: Janet R. Vos, Marian J.E. Mourits, Jakob de Vries, Jan C. Oosterwijk, and Geertruida H. de Bock, University of Groningen, University Medical Center Groningen, Groningen; Richard M. Brohet, Spaarne Hospital, Hoofddorp, the Netherlands; and Li Hsu and Kathleen E. Malone, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: de Bock
mesh_terms: D000328:Adult; D000368:Aged; D019313:BRCA1 Protein / Q000235:genetics*; D024682:BRCA2 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease; D006579:Heterozygote; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009154:Mutation; D015588:Observer Variation; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human