title: Performance of the Breast Cancer Risk Assessment Tool Among Women Age 75 Years and Older.
abstract: BACKGROUND
  The Breast Cancer Risk Assessment Tool (BCRAT, "Gail model") is commonly used for breast cancer prediction; however, it has not been validated for women age 75 years and older.
  
  
  METHODS
  We used Nurses' Health Study (NHS) data beginning in 2004 and Women's Health Initiative (WHI) data beginning in 2005 to compare BCRAT's performance among women age 75 years and older with that in women age 55 to 74 years in predicting five-year breast cancer incidence. BCRAT risk factors include: age, race/ethnicity, age at menarche, age at first birth, family history, history of benign breast biopsy, and atypia. We examined BCRAT's calibration by age by comparing expected/observed (E/O) ratios of breast cancer incidence. We examined discrimination by computing c-statistics for the model by age. All statistical tests were two-sided.
  
  
  RESULTS
  Seventy-three thousand seventy-two NHS and 97 081 WHI women participated. NHS participants were more likely to be non-Hispanic white (96.2% vs 84.7% in WHI, P < .001) and were less likely to develop breast cancer (1.8% vs 2.0%, P = .02). E/O ratios by age in NHS were 1.16 (95% confidence interval [CI] = 1.09 to 1.23, age 57-74 years) and 1.31 (95% CI = 1.18 to 1.45, age ≥ 75 years, P = .02), and in WHI 1.03 (95% CI = 0.97 to 1.09, age 55-74 years) and 1.10 (95% CI = 1.00 to 1.21, age ≥ 75 years, P = .21). E/O ratio 95% confidence intervals crossed one among women age 75 years and older when samples were limited to women who underwent mammography and were without significant illness. C-statistics ranged between 0.56 and 0.58 in both cohorts regardless of age.
  
  
  CONCLUSIONS
  BCRAT accurately predicted breast cancer for women age 75 years and older who underwent mammography and were without significant illness but had modest discrimination. Models that consider individual competing risks of non-breast cancer death may improve breast cancer risk prediction for older women.
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: Mara A
authors.initials: MA
authors.lastname: Schonberg
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: Vicky W
authors.initials: VW
authors.lastname: Li
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: A Heather
authors.initials: AH
authors.lastname: Eliassen
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: Ellen P
authors.initials: EP
authors.lastname: McCarthy
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: Bernard A
authors.initials: BA
authors.lastname: Rosner
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: Rowan T
authors.initials: RT
authors.lastname: Chlebowski
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Rohan
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hankinson
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
authors.affiliation: Affiliations of authors:Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Boston, MA (MAS, VWL, RBD, EPM, ERM, LHN); Department of Epidemiology, Harvard School of Public Health , Boston, MA and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Harvard School of Public Health , Boston, MA (AHE, BAR, SEH); Division of Epidemiology, Family and Preventive Medicine, University of California San Diego , La Jolla, CA (AZL); Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center , Torrance, CA (RTC) ; Department of Epidemiology & Population Health, Albert Einstein College of Medicine , Bronx, NY (TER); Department of Biostatistics and Epidemiology, University of Massachusetts , Amherst, MA (SEH).
authors.forename: Long H
authors.initials: LH
authors.lastname: Ngo
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D002423:Cause of Death; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D015233:Models, Statistical; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D016387:Women's Health