Background Annual surveillance mammography is recommended for women with a personal history of breast cancer. Risk prediction models that estimate mammography failures such as interval second breast cancers could help to tailor surveillance imaging regimens to women’s individual risk profiles. Methods In a cohort of women with a history of breast cancer receiving surveillance mammography in the Breast Cancer Surveillance Consortium in 1996-2019, we used LASSO-penalized regression to estimate the probability of an interval second cancer (invasive cancer or ductal carcinoma in situ) in the one-year following a negative surveillance mammogram. Based on predicted risks from this one-year risk model, we generated cumulative risks of an interval second cancer for the five-year period following each mammogram. Model performance was evaluated using cross-validation in the overall cohort and within race and ethnicity strata. Results In 173,290 surveillance mammograms, we observed 496 interval cancers. One-year risk models were well-calibrated (expected/observed ratio = 1.00) with good accuracy (area under the receiver operating characteristic curve = 0.64). Model performance was similar across race and ethnicity groups. The median five-year cumulative risk was 1.20% (interquartile range 0.93-1.63%). Median five-year risks were highest in women who were under age 40 or pre- or peri-menopausal at diagnosis and those with estrogen receptor-negative primary breast cancers. Conclusions Our risk model identified women at high risk of interval second breast cancers who may benefit from additional surveillance imaging modalities. Risk models should be evaluated to determine if risk-guided supplemental surveillance imaging improves early detection and decreases surveillance failures.

中文翻译：

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预测既往患有乳腺癌的女性五年间隔第二次患乳腺癌的风险

背景 建议有乳腺癌个人病史的女性每年进行一次乳房X线检查监测。估计乳房X光检查失败（例如间隔秒乳腺癌）的风险预测模型可以帮助根据女性的个人风险状况定制监测成像方案。方法 在 1996 年至 2019 年乳腺癌监测联盟中接受监测乳房 X 光检查的一组有乳腺癌病史的女性中，我们使用 LASSO 惩罚回归来估计间隔秒癌症（浸润癌或原位导管癌）的概率在乳房 X 光检查呈阴性后的一年内。根据这一一年风险模型的预测风险，我们生成了每次乳房 X 光检查后五年内第二次癌症的累积风险。使用整个队列以及种族和民族阶层内的交叉验证来评估模型性能。结果 在 173,290 幅监测乳房 X 光检查中，我们观察到 496 种间期癌症。一年风险模型经过良好校准（预期/观察比率 = 1.00），具有良好的准确性（受试者工作特征曲线下面积 = 0.64）。不同种族和族裔群体的模型表现相似。五年累计风险中位数为 1.20%（四分位距 0.93-1.63%）。诊断时年龄在 40 岁以下、绝经前或围绝经期的女性以及雌激素受体阴性原发性乳腺癌女性的中位五年风险最高。结论 我们的风险模型确定了患有第二次乳腺癌的高风险女性，她们可能受益于额外的影像学监测方式。应评估风险模型，以确定风险引导的补充监测成像是否可以改善早期发现并减少监测失败。