Development and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort study

Hdl Handle:
http://hdl.handle.net/10147/332783
Title:
Development and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort study
Authors:
Galvin, Rose; Joyce, Doireann; Downey, Eithne; Boland, Fiona; Fahey, Tom; Hill, Arnold K
Affiliation:
Beaumont Hospital, Royal College of Surgeons in Ireland
Citation:
BMC Cancer. 2014 Oct 03;14(1):743
Issue Date:
3-Oct-2014
URI:
http://dx.doi.org/10.1186/1471-2407-14-743; http://hdl.handle.net/10147/332783
Abstract:
Abstract Background The number of primary care referrals of women with breast symptoms to symptomatic breast units (SBUs) has increased exponentially in the past decade in Ireland. The aim of this study is to develop and validate a clinical prediction rule (CPR) to identify women with breast cancer so that a more evidence based approach to referral from primary care to these SBUs can be developed. Methods We analysed routine data from a prospective cohort of consecutive women reviewed at a SBU with breast symptoms. The dataset was split into a derivation and validation cohort. Regression analysis was used to derive a CPR from the patient’s history and clinical findings. Validation of the CPR consisted of estimating the number of breast cancers predicted to occur compared with the actual number of observed breast cancers across deciles of risk. Results A total of 6,590 patients were included in the derivation study and 4.9% were diagnosed with breast cancer. Independent clinical predictors for breast cancer were: increasing age by year (adjusted odds ratio 1.08, 95% CI 1.07-1.09); presence of a lump (5.63, 95% CI 4.2-7.56); nipple change (2.77, 95% CI 1.68-4.58) and nipple discharge (2.09, 95% CI 1.1-3.97). Validation of the rule (n = 911) demonstrated that the probability of breast cancer was higher with an increasing number of these independent variables. The Hosmer-Lemeshow goodness of fit showed no overall significant difference between the expected and the observed numbers of breast cancer (χ2 HL: 6.74, p-value: 0.56). Conclusions This study derived and validated a CPR for breast cancer in women attending an Irish national SBU. We found that increasing age, presence of a lump, nipple discharge and nipple change are all associated with increased risk of breast cancer. Further validation of the rule is necessary as well as an assessment of its impact on referral practice.
Item Type:
Article
Language:
en
Keywords:
BREAST CANCER
Local subject classification:
CLINICAL PREDICTION RULE

Full metadata record

DC FieldValue Language
dc.contributor.authorGalvin, Roseen_GB
dc.contributor.authorJoyce, Doireannen_GB
dc.contributor.authorDowney, Eithneen_GB
dc.contributor.authorBoland, Fionaen_GB
dc.contributor.authorFahey, Tomen_GB
dc.contributor.authorHill, Arnold Ken_GB
dc.date.accessioned2014-10-15T11:37:30Z-
dc.date.available2014-10-15T11:37:30Z-
dc.date.issued2014-10-03-
dc.identifier.citationBMC Cancer. 2014 Oct 03;14(1):743en_GB
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2407-14-743-
dc.identifier.urihttp://hdl.handle.net/10147/332783-
dc.description.abstractAbstract Background The number of primary care referrals of women with breast symptoms to symptomatic breast units (SBUs) has increased exponentially in the past decade in Ireland. The aim of this study is to develop and validate a clinical prediction rule (CPR) to identify women with breast cancer so that a more evidence based approach to referral from primary care to these SBUs can be developed. Methods We analysed routine data from a prospective cohort of consecutive women reviewed at a SBU with breast symptoms. The dataset was split into a derivation and validation cohort. Regression analysis was used to derive a CPR from the patient’s history and clinical findings. Validation of the CPR consisted of estimating the number of breast cancers predicted to occur compared with the actual number of observed breast cancers across deciles of risk. Results A total of 6,590 patients were included in the derivation study and 4.9% were diagnosed with breast cancer. Independent clinical predictors for breast cancer were: increasing age by year (adjusted odds ratio 1.08, 95% CI 1.07-1.09); presence of a lump (5.63, 95% CI 4.2-7.56); nipple change (2.77, 95% CI 1.68-4.58) and nipple discharge (2.09, 95% CI 1.1-3.97). Validation of the rule (n = 911) demonstrated that the probability of breast cancer was higher with an increasing number of these independent variables. The Hosmer-Lemeshow goodness of fit showed no overall significant difference between the expected and the observed numbers of breast cancer (χ2 HL: 6.74, p-value: 0.56). Conclusions This study derived and validated a CPR for breast cancer in women attending an Irish national SBU. We found that increasing age, presence of a lump, nipple discharge and nipple change are all associated with increased risk of breast cancer. Further validation of the rule is necessary as well as an assessment of its impact on referral practice.-
dc.language.isoenen
dc.subjectBREAST CANCERen_GB
dc.subject.otherCLINICAL PREDICTION RULEen_GB
dc.titleDevelopment and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort studyen_GB
dc.typeArticleen
dc.contributor.departmentBeaumont Hospital, Royal College of Surgeons in Irelanden_GB
dc.language.rfc3066en-
dc.rights.holderRose Galvin et al.; licensee BioMed Central Ltd.-
dc.description.statusPeer Reviewed-
dc.date.updated2014-10-11T15:02:45Z-
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