Performance of three breast cancer risk assessment tools in US Black women

Breast cancer risk prediction models aid identification of high-risk women for earlier or more frequent screening. The two most commonly used U.S. models appear to perform less well in Black women, possibly because Black women have a lower proportion of ER-positive breast cancer. A cohort study compared the performance of the Black Women’s Health Study (BWHS) model, the NCI Breast Cancer Risk Assessment Tool (BCRAT), and the International Breast Cancer Intervention Study (IBIS) in a large cohort of Black women (n=50,235) followed over four sequential 5 year periods. Predictors were updated at the start of each 5 year period. A total of 2041 invasive breast cancers occurred. Calibration metrics, expected over observed number of cancers, were 0.99 (0.94-1.04), 0.97 (0.93-1.02), and 1.13 (1.08-1.18) from the BWHS, BCRAT, and IBIS models, respectively, whereas the metrics for discriminatory accuracy, age-adjusted area under the curve (AUC) were 0.58 (0.56-0.59), 0.56 (0.55-0.57), and 0.56 (0.55-0.57), respectively. The authors conclude that in this comparison, the BHWS model had better calibration and discrimination than BCRAT and IBIS, indicating a benefit to using the BWHS model for Black women.