A new model for calculating invasive breast cancer risk, called the CARE model, has been found to give better estimates of the number of breast cancers that would develop in African American women 50 to 79 years of age than an earlier model which was based primarily on data from white women. Both models were designed to be used by health care professionals and should either be used by them or in consultation with them. Researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, and their collaborators report on the study methodology and results online in JNCI on November 27, 2007.

The NCI investigators worked with colleagues from the Women's Contraceptive and Reproductive Experiences (CARE) Study, the Women's Health Initiative, and the Study of Tamoxifen and Raloxifene trial (a breast cancer prevention trial) to produce and test the new model. Some members of the team had worked on both the CARE and earlier model, called BCRAT (Breast Cancer Risk Assessment Tool). Because of the higher accuracy of the CARE model for African American women, the NCI authors are now recommending its use for counseling these women regarding their risk of breast cancer.

"NCI's Breast Cancer Risk Assessment Tool has been widely used for counseling women and determining eligibility for breast cancer prevention trials," said NCI Director John E. Niederhuber, M.D. "The development of the CARE model highlights the need to develop targeted tools to assess an individual woman's risk, and those tools must be based on many factors that also assure that the tool can be used in a non-discriminatory manner."
While the BCRAT allows for projections for African American women and for women from other racial and ethnic groups, these projections are based on certain assumptions. In particular, it is assumed that the relative risk of breast cancer associated with having a specific profile of risk factors for white women applies to African American women and to women from other racial and ethnic groups as well. Because of the need to rely on these various assumptions, rather than on sufficient data from African American women and women in other racial and ethnic groups, BCRAT, which can be found on the NCI Web site at http://www.cancer.gov/bcrisktool, includes a disclaimer for African American women and for women in other groups that their projections might be inaccurate.

To develop a new model that would more accurately assess an African American's woman's chance of developing breast cancer, researchers in the CARE study examined data from 1,607 African American women with invasive breast cancer and 1,637 African American women of similar ages who did not have breast cancer. The factors used in the model were age at first menstrual period, number of first degree relatives (mother or sisters) who had breast cancer, and number of previous benign breast biopsy examinations. A woman's age at the birth of her first child, a risk factor for white women, did not improve prediction in African American women and so was not included in the model. Risk was calculated by combining information on these factors with African American rates of new invasive breast cancer from NCI's Surveillance, Epidemiology and End Results Program and with national mortality data.

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