Prediction Model: Breast Cancer in Women Irradiated for a Pediatric Malignancy

预测模型：因儿童恶性肿瘤接受放射治疗的女性乳腺癌

• 批准号: 8210899
• 负责人: CHAYA MOSKOWITZ
• 金额: $ 38.5万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2014-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8210899
• 关键词: Abdomen; Accounting; Address; Age; Age at First Live Birth; Age at Menarche; Alkylating Agents; American; Atypical hyperplasia; Biopsy; Body mass index; Breast; Breast Cancer Detection; Breast Cancer Model; Breast Cancer Risk Assessment Tool; Breast Cancer Risk Factor; Canada; Cancer Survivor; Chest; Child; Childhood; Childhood Cancer Survivor Study; Children' s Oncology Group; Clinical; Computer Assisted; Conflict (Psychology); Contraceptive Usage; Data; Data Set; Diagnosis; Disease; Dose; Dose-Limiting; Family; Female; First Degree Relative; Future; Goals; Guidelines; Hormone replacement therapy; Hormones; Individual; International; Knowledge; Late Effects; Literature; Lung; Magnetic Resonance Imaging; Malignant Childhood Neoplasm; Malignant Neoplasms; Mammary Gland Parenchyma; Mammography; Mantle Field; Mediastinal; Menopause; Modeling; Morbidity - disease rate; Oral Contraceptives; Outcome; Ovarian; Participant; Patients; Pelvis; Physicians; Population; Population Study; Premature Mortality; Prevention; Prevention strategy; Probability; Quality of life; Radiation; Radiation therapy; Recommendation; Recording of previous events; Registries; Relative (related person); Reproductive History; Research Project Grants; Resources; Risk; Risk Factors; Screening procedure; Spinal; Staging; Survival Rate; Survivors; Therapeutic; Time; United States; Validation; Whole-Body Irradiation; Woman; base; cancer diagnosis; cancer risk; cancer therapy; clinical practice; cohort; design; improved; malignant breast neoplasm; mortality; public health relevance; standard of care; tool; user friendly software

DESCRIPTION (provided by applicant): Survivors of a pediatric malignancy are at risk for serious long-term morbidity and premature mortality related to their treatment. Women who were treated with chest radiation for their childhood cancer have an increased risk of developing breast cancer at a young age. We use the term chest radiation to refer to radiation that includes the following fields: mantle, mediastinal, lung, total body irradiation, or spinal. Models for predicting the absolute risk of breast cancer, such as the well-known Gail model, have been used extensively to advise patients on their individual risk of developing breast cancer and to design prevention trials. The majority of these risk calculators are not immediately applicable to survivors of a previous malignancy who have a risk that is modified by previous treatments. Moreover, there is conflicting evidence as to whether various non-treatment related factors, including the traditional breast cancer risk factors, are associated with the risk of breast cancer in these women. The traditional risk factors include age, age at menarche, age at birth of first live child, number of first-degree relatives with breast cancer, number of previous breast biopsies, and history of atypical hyperplasia. We propose to utilize the unique resources of the North American Childhood Cancer Survivor Study (CCSS) and the Dutch LATe Effect Registry (LATER) cohorts. Our first aim is to develop a risk prediction model that integrates chest radiation dose and volume, treatment-related exposures, the traditional risk factors, and other possible risk factors such as age at menopause, body mass index, the number of years with intact ovarian function after radiotherapy, and use of hormone replacement or oral contraceptive therapy, in order to estimate the individualized absolute risk of breast cancer for women who were treated with chest radiation for a childhood cancer. The model will be developed using the original CCSS cohort in which there are 1,677 female participants who were treated with chest radiation and would be included in this analysis. Of these 1,677 women, 187 women had developed breast cancer by the time of this application. Our second aim is to validate the prediction model on independent data. The validation cohort will consist of about 1225 female participants in the expanded CCSS cohort and 1087 female participants in the Dutch LATER cohort. We estimate that approximately 100 of these women will have breast cancer. The third aim is to create and disseminate a risk calculator that provides computer-assisted risk prediction. Our objective is to present a tool in an easily accessible format and disseminate it for clinical use by physicians and patients. The long-term goals of this project are to provide a means for facilitating conversations between physicians and their patients about appropriate screening and preventive strategies and to help refine screening recommendations for this population. PUBLIC HEALTH RELEVANCE: Women who were treated with chest radiation for a childhood cancer are at risk of developing breast cancer at a young age. We aim to quantify a woman's individualized risk of breast cancer as a function of the dose of radiation to the chest, other treatment-related factors, the traditional breast cancer risk factors such as family and reproductive histories, and other non-treatment related risk factors. This risk prediction model has the potential to facilitate conversations between physicians and patients and to help refine current screening recommendations for female survivors of a pediatric cancer.

描述（由申请人提供）：小儿恶性肿瘤的幸存者有严重的长期发病率和与治疗相关的过早死亡的风险。接受儿童癌症胸部辐射治疗的妇女在年轻时患乳腺癌的风险增加。我们使用术语胸部辐射来指代包括以下磁场的辐射：地幔，纵隔，肺，全身受照射或脊柱。 已广泛使用用于预测乳腺癌绝对风险的模型，例如著名的盖尔模型，以向患者提供有关患乳腺癌的个人风险和设计预防试验的建议。这些风险计算器中的大多数不适用于先前具有先前治疗风险的恶性肿瘤的幸存者。此外，有矛盾的证据表明，包括传统乳腺癌危险因素在内的各种非治疗因素是否与这些女性患乳腺癌的风险有关。传统的危险因素包括年龄，初潮年龄，第一个活着的孩子的年龄，乳腺癌的一级亲戚的数量，以前的乳房活检数量以​​及非典型增生史。 我们建议利用北美儿童癌症幸存者研究（CCSS）和荷兰晚期效应注册中心（后来）的独特资源。我们的第一个目的是开发一种风险预测模型，该模型整合胸部辐射剂量和体积，与治疗相关的暴露，传统的风险因素以及其他可能的风险因素，例如年龄在绝经期，体重指数，体重指数，放射疗法后具有完整卵巢功能的年数，以及用于对胸腔癌症的胸腔替代或术语的使用，以使胸腔治疗的胸部癌症疗法是绝对癌症的妇女疗法，这些风险是绝对癌症的妇女疗法，这些妇女的疗法是绝对癌症的，这些风险是绝对癌症的，这些疗法是绝对癌症的术语。 癌症。该模型将使用原始的CCSS队列开发，其中有1,677名女性参与者接受了胸辐射治疗，并将包括在此分析中。在这1,677名妇女中，有187名妇女在此应用时患上了乳腺癌。我们的第二个目标是验证独立数据的预测模型。验证队列将由大约1225名CCSS队列中的女性参与者和后来的荷兰人群中的1087名女性参与者组成。我们估计大约100名女性将患有乳腺癌。第三个目的是创建和传播提供计算机辅助风险预测的风险计算器。我们的目标是以易于访问的格式呈现工具，并将其传播，以供医生和患者使用。该项目的长期目标是为医师与患者之间的对话提供一种有关适当筛查和预防策略的方法，并帮助完善该人群的筛查建议。 公共卫生相关性：接受儿童癌症胸部辐射治疗的妇女在年轻时就有患乳腺癌的风险。我们旨在量化妇女的乳腺癌个性风险，这是对胸部辐射的剂量，其他与治疗相关的因素，传统的乳腺癌危险因素（例如家庭和生殖历史）以及其他与其他与治疗相关的风险因素的关系。这种风险预测模型有可能促进医生与患者之间的对话，并帮助完善针对小儿癌女性幸存者的当前筛查建议。