title: Enhancing Breast Cancer Recurrence Algorithms Through Selective Use of Medical Record Data.
abstract: BACKGROUND
  The utility of data-based algorithms in research has been questioned because of errors in identification of cancer recurrences. We adapted previously published breast cancer recurrence algorithms, selectively using medical record (MR) data to improve classification.
  
  
  METHODS
  We evaluated second breast cancer event (SBCE) and recurrence-specific algorithms previously published by Chubak and colleagues in 1535 women from the Life After Cancer Epidemiology (LACE) and 225 women from the Women's Health Initiative cohorts and compared classification statistics to published values. We also sought to improve classification with minimal MR examination. We selected pairs of algorithms-one with high sensitivity/high positive predictive value (PPV) and another with high specificity/high PPV-using MR information to resolve discrepancies between algorithms, properly classifying events based on review; we called this "triangulation." Finally, in LACE, we compared associations between breast cancer survival risk factors and recurrence using MR data, single Chubak algorithms, and triangulation.
  
  
  RESULTS
  The SBCE algorithms performed well in identifying SBCE and recurrences. Recurrence-specific algorithms performed more poorly than published except for the high-specificity/high-PPV algorithm, which performed well. The triangulation method (sensitivity = 81.3%, specificity = 99.7%, PPV = 98.1%, NPV = 96.5%) improved recurrence classification over two single algorithms (sensitivity = 57.1%, specificity = 95.5%, PPV = 71.3%, NPV = 91.9%; and sensitivity = 74.6%, specificity = 97.3%, PPV = 84.7%, NPV = 95.1%), with 10.6% MR review. Triangulation performed well in survival risk factor analyses vs analyses using MR-identified recurrences.
  
  
  CONCLUSIONS
  Use of multiple recurrence algorithms in administrative data, in combination with selective examination of MR data, may improve recurrence data quality and reduce research costs.
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA (CHK, AC, EW, BJC); Group Health Research Institute, Seattle, WA (JC); Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA (LJ). candyce.h.kroenke@kp.org.
authors.forename: Candyce H
authors.initials: CH
authors.lastname: Kroenke
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA (CHK, AC, EW, BJC); Group Health Research Institute, Seattle, WA (JC); Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA (LJ).
authors.forename: Jessica
authors.initials: J
authors.lastname: Chubak
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA (CHK, AC, EW, BJC); Group Health Research Institute, Seattle, WA (JC); Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA (LJ).
authors.forename: Lisa
authors.initials: L
authors.lastname: Johnson
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA (CHK, AC, EW, BJC); Group Health Research Institute, Seattle, WA (JC); Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA (LJ).
authors.forename: Adrienne
authors.initials: A
authors.lastname: Castillo
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA (CHK, AC, EW, BJC); Group Health Research Institute, Seattle, WA (JC); Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA (LJ).
authors.forename: Erin
authors.initials: E
authors.lastname: Weltzien
authors.affiliation: Kaiser Permanente Northern California, Division of Research, Oakland, CA (CHK, AC, EW, BJC); Group Health Research Institute, Seattle, WA (JC); Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA (LJ).
authors.forename: Bette J
authors.initials: BJ
authors.lastname: Caan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008499:Medical Records; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology