Abstract
The Gail model is considered the best available means for estimating risk of breast cancer development, but it has not yet been applied systematically and validated in Turkish female population. This study was designed to evaluate the performance of the Gail model for Turkish female population. Additionally duration of breastfeeding was examined as a possible risk factor. Our analysis included 650 patients with invasive breast carcinoma (group 1) and 640 women with negative results who had undergone a screening mammography on visiting a mammary care unit (group 2). Two groups were compared with regard to individual risk factors included in the Gail model and also duration of breastfeeding. The Gail model was used to predict 5-year risk for each woman. Age and first live birth ≥30 years were associated with an increased relative risk for breast cancer development. Age at menarche, previous breast biopsy, atypical hyperplasia, and number of first degree relatives with breast cancer were found to be non-significant. The Gail model showed 13.3% sensitivity and 92% specificity in estimating the risk of breast cancer development in Turkish women. Positive predictive value was 63%, negative predictive value was 51.9%, and validity index was 53.1%. Duration of breastfeeding was significantly longer in group 1 than 2 (median 17 vs. 13 months). The proportion of parous women with no breastfed was higher in group 1 than 2. The currently used Gail model does not seem to be an appropriate breast cancer risk assessment tool for Turkish female population.
Similar content being viewed by others
References
Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Ministry of Health: The most frequent ten cancers in females in Turkey (2003) http://212.175.169.156/KSDB/BelgeGoster.aspx?F6E10F8892433CFFAC8287D72AD903BE00EA04F0B1B62666
Ottoman R, Pike MC, King MC, Henderson BE (1983) Practical guide for estimating risk for familial breast cancer. Lancet ii:556–558
Claus EB, Risch N, Thompson WD (1994) Autosomal dominant inheritance of early onset breast cancer: implications for risk prediction. Cancer 73:643–651
Gail MH, Brinton LA, Byar DP, Corle DK, Gren SB, Schairer C et al (1989) Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 81:1879–1886
Constantino J, Gail MH, Pee D, Anderson S, Redmond CK, Benichou J et al (1999) Validation studies for models projecting the risk of invasive and total breast cancer incidence. J Natl Cancer Inst 91:1541–1548
National Cancer Institute. SEER Cancer Statistics Review, 1973–1997. http://seer.cancer.gov/publications/CSR1973-1997
Rockhill B, Spiegelman D, Bryne C, Hunter DJ, Colditz GA (2001) Validation of the Gail et al. model of breast cancer risk prediction and implications for chemoprevention. J Natl Cancer Inst 93:358–366
Spiegelman D, Colditz GA, Hunter D, Hertzmark E (1994) Validation of the Gail et al. model for predicting individual breast cancer risk. J Natl Cancer Inst 86:600–607
Bondy ML, Lustbader ED, Halabi S, Ross E, Vogel VG (1994) Validation of a breast cancer risk assessment model in women with positive family history. J Natl Cancer Inst 86:620–625
Freedman AN, Seminara D, Gail MH, Hartge P, Colditz GA, Ballar-Barbash R et al (2005) Cancer risk prediction models: a workshop on development, evaluation, and application. J Natl Cancer Inst 97:715–723
Fisher B, Constantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM et al (1998) Tamoxifen for prevention of breast cancer: a report of the National Surgical Adjuvant Breast Bowel Project P-1. J Natl Cancer Inst 90:1371–1388
Wickerham DL (2003) Tamoxifen’s impact as a preventive agent in clinical practice and an update on the STAR trial. Recent Results Cancer Res 163:87–95
Levi F, Lucchini F, Negri E, Boyle P, La Vecchia C (2003) Mortality from major cancer sites in the Europe Union 1955-1998. Ann Oncol 14:490–495
Althuis MD, Dozier JM, Anderson WF, Devesa SS, Brinton LA (2005) Global trends in breast cancer incidence and mortality 1973-1997. Int J Epidemiol 34:405–412
Edwards BK, Brown ML, Wingo PA, Howe HL, Ward E, Ries LA et al (2005) Annual report to the nation on the status of cancer, 1975-2002, featuring population-based trends in cancer treatment. J Natl Cancer Inst 97:1407–1427
Novotny J, Pecen L, Petruzelka L, Svobodnik A, Dusek L, Danes J et al (2006) Breast cancer risk assessment in the Czech female population—an adjustment of the original Gail model. Breast Cancer Res Treat 95:29–35
Boyle P, Mezzetti M, La Vecchia C, Franceschi S, Decarli A, Robertson C (2004) Contribution of three components to individual cancer risk predicting breast cancer risk in Italy. Eur J Cancer Prev 13:183–191
Decarli A, Cazla S, Masala G, Specchia C, Palli D, Gail MH (2006) Gail model for prediction of absolute risk of invasive breast cancer: independent evaluation in the Florence-European prospective investigation into cancer and nutrition cohort. J Natl Cancer Inst 98:1686–1693
Pastor Climente IP, Morales Suárez-Varela MM, Llopis González A, Magraner Gil JF (2005) Application of the Gail method of calculating risk in the population of Valencia. Clin Transl Oncol 7:336–343
Bondy ML, Newman LA (2003) Breast cancer risk assessment models: applicability to African-American women. Cancer 97(1 Suppl):230–235
Medina-Franco H, Garza E, Gabilondo B, Gaona-Luviano P (2004) Risk of invasive breast cancer in Mexican population and patterns of screening and prophylaxis. Rev Invest Clin 56:422–426
Ozmen V, Ozcinar B, Karanlik H, Cabioglu N, Tukenmez M, Disci R et al (2009) Breast cancer risk factors in Turkish women—a University Hospital based nested case control study. World J Surg Oncol 7:37 (Epub ahead of print)
Yang L, Jacobsen KH (2008) A systematic review of the association between breastfeeding and breast cancer. J Womens Health (Larchmt) 17:1635–1645
Collaborative Group on Hormonal Factors in Breast Cancer (2002) Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet 360:187–195
Lord SJ, Bernstein L, Johnson KA, Malone KE, McDonald JA, Marchbanks PA et al (2008) Breast cancer risk and hormone receptor status in older women by parity, age of first birth and breastfeeding: a case-control study. Cancer Epidemiol Biomarkers Prev 17:1723–1730
Byers T, Graham S, Rzepka T, Marshall J (1985) Lactation and breast cancer. Evidence for a negative association in premenopausal women. Am J Epidemiol 12:664–674
Key TJ, Pike MC (1988) The role of oestrogens and progestagens in the epidemiology and prevention of breast cancer. Eur J Cancer Clin Oncol 24:29–34
Petrakis NL, Wrensch MR, Ernster VL, Miike R, Murai J, Simberg N et al (1987) Influence of pregnancy and lactation on serum and breast fluid estrogen levels: implications for breast cancer risk. Int J Cancer 40:587–591
Murrell TG (1991) Epidemiological and biochemical support for a theory on the cause and prevention of breast cancer. Med Hypotheses 36:389–396
Gruenke LD, Wrensch MR, Petrakis NL, Miike R, Ernster VL, Craig JC (1987) Breast fluid cholesterol and cholesterol epoxides: relationship to breast cancer risk factors and other characteristics. Cancer Res 47:5483–5487
Kennedy KI (1994) Effects of breast-feeding on women’s health. Int J Gynaecol Obstet 47(Suppl):S11–S21
Russo J, Russo IH (1994) Toward a physiological approach to breast cancer prevention. Cancer Epidemiol Biomarkers Prev 3:353–364
Henderson BE, Pike MC, Casagrande JT (1981) Breast cancer and the oestrogen window hypothesis. Lancet 2:363–364
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ulusoy, C., Kepenekci, I., Kose, K. et al. Applicability of the Gail model for breast cancer risk assessment in Turkish female population and evaluation of breastfeeding as a risk factor. Breast Cancer Res Treat 120, 419–424 (2010). https://doi.org/10.1007/s10549-009-0541-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10549-009-0541-8