Risk Assessment and Screening Tools November 17, 2010

Transcription

1 Risk Assessment and Screening Tools November 17, 2010 Cecelia Bellcross Posted in the Resource Repository at: s/

2 Cecelia Bellcross Emory University School of Medicine Department of Human Genetics

3 The right tool for the right situation Type of risk assessment Hereditary Empiric Purpose Accuracy Validation Discrimination Target audience Screen Consumer Detailed risk assessment Healthcare provider Disease/Condition Single type of cancer Multiple types of cancer Multiple diseases Venue Web-based EMR interface Paper/pencil

4 www8.utsouthwestern.edu/utsw/cda/dept47829/files/65844.html

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6 Benefits Easy access/use Updated regularly to include latest data Well-validated Adjusts for tumor pathology and oophorectomy Other hereditary cancers included in CancerGene Limitations Does not incorporate non-familial factors Does not account for non-brca1/2 genetic contribution to breast/ovarian cancer risk Half-siblings not incorporated Pancreatic, prostate and melanoma cancers not included in BRCA mutation predictions Parmigiani, Am J Hum Genet 1998;62:145 Berry, J Clin Oncol 2002;20:21

7 BOADICEA Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm Antoniou, AC. Br J Ca, 2002;86:76 Antoniou, AC. Br J Ca, 2004;91:1580 Antoniou, AC. Br J Ca, 2008;98:1457

8 2.0 BOADICEA risk calculation results The BOADICEA model predicts the following BRCA1 and BRCA2 gene mutation carrier probabilities and breast/ovarian cancer risks for this individual: Genetic status No mutation BRCA1 BRCA2 Age Mutation carrier probabilities Breast cancer risks Ovarian cancer risks

9 BOADICEA Benefits Limitations Incorporates multiple genetic effects Family history incorporated can be very complete (halfsibs, 3rd degree) Adjusts for cohort effects Includes pancreatic and prostate cancer in BRCA calculations Provides risks for contralateral breast cancer & ovarian cancer Does not account for non-genetic factors Does not adjust for breast cancer pathology or previous oophorectomy Does not adjust for race Pedigree entry requires very detailed history and is timeconsuming Exclusive to breast/ovarian cancer

10 IBIS Model (Tyrer-Cusick) Tyrer J. A breast cancer prediction model incorporating familial and personal risk factors. Statist Med 2004; 23:1111 IBIS Breast Cancer Risk Evaluation Tool

11 Person is premenopausal. Lifetime population risk is 9.736%. Height is 5 ft 5 ins. Probability of a BRCA1 gene is 0.029%. Weight is 10 st 0 lb. Probability of a BRCA2 gene is 0.169%. Woman's age is 40 years. Risk after 10 years is 3.693%. Age at menarche was 12 years. 10 year population risk is 1.606%. Age at first birth was 25 years. Lifetime risk is 21.85%. Woman has never used HRT. Person is premenopausal. Lifetime population risk is 9.736%. Height is 5 ft 5 ins. is 0.029%. Probability of a BRCA1 gene Weight is 10 st 0 lb. Probability of a BRCA2 gene is 0.169%. Woman has never used HRT % % 13.2% Personal risk 22.0% Population risk 8.8% 17.6% 4.4% 13.2% 22.0% 0.0% % Personal risk Population risk

12 Benefits IBIS Model Incorporate both genetic and non-genetic risk factors Easy data entry, but requires extensive family history details Adjusts for number/age of unaffected 1st and 2nd degree relatives Provides age-adjusted risks compared to population in graph form Limitations Limited validation data Model assumes non-genetic factors multiplicative on risk and of same magnitude across all genotypes Underestimates risk in women with strong family histories Overestimates risk in women with less strong family histories Dramatic increase in risk for women with atypia and positive family history

13 Benefits Limitations Easy access/use Incorporates reproductive factors Adjusts for race Well-validated on a population basis Does not incorporate 2nd degree relatives with breast cancer, age of diagnosis, or presence of ovarian cancer May over-estimate risk in women with multiple benign breast biopsies Has lower accuracy for individual risk prediction Uses older population prevalence data associated with lower baseline incidence rates

14 Benefits Accounts for breast cancer in both 1st and 2nd degree relatives Age of onset in decades Validated using data from a large casecontrol study Limitations Does not incorporate non-familial factors Does not account for certain combinations of family members Does not include bilateral breast cancer or ovarian cancer* Lifetime risk tables reflect risks for N. American women in the 1980 s *Jonker MA. Cancer Epi Biomarkers Prev. 2003;12:1479 (Claus Extended)

15 Model Variability Model BRCA1/2 mutation Br CA risk () Ov CA risk () BRCAPRO 19% 14% 7% BOADICEA 19% 17% 6% IBIS 12% 18% Comm Oncol 2009;6:373 N/A

16 Model Variability Model BRCA1/2 mutation Br CA risk () Ov CA risk () BRCAPRO < 1% 7% < 1% BOADICEA < 1% 8% 1% IBIS < 1% 14% Comm Oncol 2009;6:373 N/A

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18 NCI Colon Cancer This tool cannot accurately estimate risk of colorectal cancer for people who have the following problems: Ulcerative colitis Crohn disease Familial adenomatous polyposis (FAP) Hereditary Nonpolyposis Colorectal Cancer (HNPCC) Personal history of colorectal cancer

19 Other tools & screeners B-RST Hughes riskapps - Breast Cancer Risk Screening Tool (Pedigree Assessment Tool)- es/bcra.aspx Family HealthLink (cancer, CHD) MMR Predict - Cleveland Clinic Colorectal Cancer Risk Assessment - Prostate Cancer Risk Assessment - Harvard School of Public Health Disease Risk Index (Cancer) -