Validation of a Dynamic Risk Prediction Model Incorporating Prior Mammograms in a Diverse Population
Menée aux Etats-Unis auprès de 206 929 femmes âgées de 40 à 74 ans (âge moyen : 56 ans ; durée moyenne de suivi : 5,3 ans), cette étude évalue, en fonction de l'origine ethnique et de catégories d'âge, la performance d'un modèle dynamique basé sur des mammogrammes pour prédire le risque de développer un cancer du sein
Importance : For breast cancer risk prediction to be clinically useful, it must be accurate and applicable to diverse groups of women across multiple settings.
Objective : To examine whether a dynamic risk prediction model incorporating prior mammograms, previously validated in Black and White women, could predict future risk of breast cancer across a racially and ethnically diverse population in a population-based screening program.
Design, Setting, and Participants : This prognostic study included women aged 40 to 74 years with 1 or more screening mammograms drawn from the British Columbia Breast Screening Program from January 1, 2013, to December 31, 2019, with follow-up via linkage to the British Columbia Cancer Registry through June 2023. This provincial, organized screening program offers screening mammography with full field digital mammography (FFDM) every 2 years. Data were analyzed from May to August 2024.
Exposure : FFDM-based, artificial intelligence–generated mammogram risk score (MRS), including up to 4 years of prior mammograms.
Main Outcomes and Measures : The primary outcomes were 5-year risk of breast cancer (measured with the area under the receiver operating characteristic curve [AUROC]) and absolute risk of breast cancer calibrated to the US Surveillance, Epidemiology, and End Results incidence rates.
Results : Among 206 929 women (mean [SD] age, 56.1 [9.7] years; of 118 093 with data on race, there were 34 266 East Asian; 1946 Indigenous; 6116 South Asian; and 66 742 White women), there were 4168 pathology-confirmed incident breast cancers diagnosed through June 2023. Mean (SD) follow-up time was 5.3 (3.0) years. Using up to 4 years of prior mammogram images in addition to the most current mammogram, a 5-year AUROC of 0.78 (95% CI, 0.77-0.80) was obtained based on analysis of images alone. Performance was consistent across subgroups defined by race and ethnicity in East Asian (AUROC, 0.77; 95% CI, 0.75-0.79), Indigenous (AUROC, 0.77; 95% CI 0.71-0.83), and South Asian (AUROC, 0.75; 95% CI 0.71-0.79) women. Stratification by age gave a 5-year AUROC of 0.76 (95% CI, 0.74-0.78) for women aged 50 years or younger and 0.80 (95% CI, 0.78-0.82) for women older than 50 years. There were 18 839 participants (9.0%) with a 5-year risk greater than 3%, and the positive predictive value was 4.9% with an incidence of 11.8 per 1000 person-years.
Conclusions and Relevance : A dynamic MRS generated from both current and prior mammograms showed robust performance across diverse racial and ethnic populations in a province-wide screening program starting from age 40 years, reflecting improved accuracy for racially and ethnically diverse populations.
JAMA , article en libre accès, 2025