Risk Models for Deciding Whether to Take Tamoxifen to Prevent Breast Cancer and for Allocating Public Health Resources

• Activity Number: 602
• Type: Invited
• Date/Time: Thursday, August 5, 2010 : 8:30 AM to 10:20 AM
• Sponsor: Section on Statistics in Epidemiology
• Author(s): Mitchell H. Gail*+
• Companies: National Cancer Institute
• Keywords: absolute risk models ; cancer prevention ; clinical utility ; cost constraints ; cumulative incidence ; resource allocation

Abstract

The National Cancer Institute's Breast Cancer Risk Assessment Tool (BCRAT), which is based on factors such as family history, has been used to assist in deciding whether to take tamoxifen to prevent breast cancer, because the risk of breast cancer must be high enough to overcome possible adverse effects of tamoxifen. Recently, seven single nucleotide polymorphisms (SNPs) were found to be associated with breast cancer risk. I evaluate how much the expected losses in the decision to take tamoxifen can be reduced, compared to using BCRAT, by adding seven SNPs to the BCRAT model. Another application of risk models could be to allocate a scarce public health resource, such as funds for mammographic screening, by giving mammograms to the women at highest risk. I assess how much adding the seven SNPs improves efficiency, compared to BCRAT. Adding SNPs conferred little benefit.