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Original Article
Novel Breast Cancer Risk Assessment Tools for Pre- and Post-Menopausal Asian Women: Development and Validation in a Nationwide Mammographic Screening Cohort
Wonyoung Jung1orcid , Yong-Moon Mark Park2,3orcid , Sang Hyun Park4, Kyungdo Han5, Junhee Park6, Yohwan Yeo7, Jung Kwon Lee6, Dale P. Sandler8, Dong Wook Shin6,9orcid

DOI: https://doi.org/10.4143/crt.2024.861 [Accepted]
Published online: January 31, 2025
1Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
2Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
3Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
4Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
5Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
6Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
7Department of Family Medicine, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong, Korea
8Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC, USA
9Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea

* An abstract was presented at the AACR annual meeting 2023, Orlando, Florida, April 18, 2023.
Corresponding author:  Yong-Moon Mark Park
Tel: 1-501-526-6186  Email: YPark@uams.edu
Dong Wook Shin
Tel: 82-2-3410-5252  Email: dwshin.md@gmail.com
Received: 4 September 2024   • Accepted: 30 January 2025
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Purpose
Widely used breast cancer risk-prediction tools are based on data from Western countries, but risk factors may differ for Asian women. Hence, we aimed to develop a risk assessment tool for breast cancer in Asian women using a nationwide, population-based mammographic screening cohort.
Materials and Methods
Women aged ≥40 years who underwent breast cancer screening and general health examination in 2009 were included. Age, body mass index (BMI), breast density, lifestyle and reproductive factors, and comorbidities were used to develop 5-year breast cancer risk-prediction models for premenopausal (n=771,856) and postmenopausal (n=1,108,047) women at baseline. The best-fit risk prediction model was constructed using backward stepwise selection in a Cox proportional hazards model and was transformed into a risk score nomogram. The performance was assessed by discrimination and calibration.
Results
In premenopausal women, high BMI, low parity, short breastfeeding period, early age at menarche, high breast density, a history of benign breast masses, and family history of breast cancer contributed to the risk prediction of breast cancer. In postmenopausal women, age, diabetes mellitus, dyslipidemia, late-onset menopause, and hormone replacement therapy use were additional risk predictors of breast cancer. Our risk-prediction model showed a concordant statistic of 0.58 (0.57–0.59) for premenopausal women and 0.64 (0.63–0.65) for postmenopausal women. The calibration plot demonstrated good correlations for both models.
Conclusion
Our breast cancer risk-prediction model demonstrated performance comparable to that of Western countries, especially among postmenopausal women. This provides a foundation for implementing risk-based screening recommendations in Asian women.

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