Inclusion of Endogenous Hormone Levels Improves Risk Prediction for Postmenopausal Breast Cancer
In a study reported in the Journal of Clinical Oncology, Tworoger et al found that inclusion of endogenous hormone levels in the Gail and Rosner-Colditz risk scores improved prediction of postmenopausal invasive breast cancer.
Study Details
The study involved 437 patients with breast cancer and 755 controls not using postmenopausal hormone therapy in the Nurses’ Health Study. Investigators assessed the effect of adding plasma levels of estradiol, estrone, estrone sulfate, testosterone, dehydroepiandrosterone sulfate, prolactin, and sex hormone–binding globulin (SHBG) to Gail and Rosner-Colditz risk scores on area under the curve (AUC) for 5-year risk of postmenopausal invasive breast cancer.
Each hormone was associated with breast cancer risk (relative risk [RR] per doubling of hormone level = 0.82 for SHGB and 1.15–1.37 for other hormones). Inclusion of individual hormones improved the AUC by 1.3 to 5.2 units for the Gail score and by 0.3 to 2.9 units for the Rosner-Colditz score.
Overall Risk Prediction
Simultaneous inclusion of estrone sulfate, testosterone, and prolactin, selected on the basis of stepwise regression, increased the AUC by 5.9 units (P = .003) for the Gail score and 3.4 units (P = .04) for the Rosner-Colditz score. After adjusting for predicted risk including either score alone, the RR for a 1 quartile increase in the predicted risk when adding the three hormones was 1.3 (P < .001) for the Gail score and 1.4 (P < .001) for the Rosner-Colditz score. In cross-validation, the average AUC change across validation data sets was 6.0 (P = .002) and 3.0 units (P = .03), respectively.
Estrogen Receptor–Positive Disease
In analysis of estrogen receptor–positive disease, simultaneous inclusion of estrone sulfate, testosterone, prolactin, and SHBG on the basis of selection by stepwise regression increased the AUC by 8.8 units (P < .001) for the Gail score and 5.8 units (P = .004) for the Rosner-Colditz score. After adjusting for predicted risk of estrogen receptor–positive disease using either score alone, the relative RR for a 1 quartile increase in the predicted risk when adding the four hormones was 1.5 (P < .001) for the Gail score and 1.6 (P < .001) for the Rosner-Colditz score. In cross-validation, the average AUC change across validation sets was 7.3 units (P = .001) for the Gail score and 4.5 units (P = .01) for the Rosner-Colditz score.
The investigators concluded: “Our results support that endogenous hormones improve risk prediction for invasive breast cancer and could help identify women who may benefit from chemoprevention or more screening.”
Shelley S. Tworoger, PhD, of Brigham and Women’s Hospital and Harvard Medical School, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by grants from the National Institutes of Health. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
