Gail乳腺癌风险评估模型的应用价值初探

[目的] 探讨Gail乳腺癌风险评估模型在上海市黄浦区范围内评估乳腺癌高危人群的应用价值。[方法] 采用病例对照研究回顾性地调查了黄浦区户籍的156例乳腺癌病例和198例年龄匹配的对照人群，对年龄、乳腺疾病史、家族史、初潮年龄、初产年龄、乳腺活检情况及种族的资料，应用Gail乳腺癌风险评估模型评估5年前的发病风险。[结果] 病例组72例及对照组11例，经模型评估后提示有5年内乳腺癌发病高风险。Gail模型作为诊断试验的评价结果，其灵敏度为50.3%，特异度为92.0%，阳性预测值为86.7%，阴性预测值为64.0%（χ²=60.09，P=0.000；配对χ²=43.90，P=0.000），约登指数为0.423，总一致性为70.7%。[结论] Gail乳腺癌风险评估模型在本研究中对乳腺癌发病高风险人群的预测价值没有达到预期效果，其作为高风险人群乳腺癌筛查的工具还有待进一步研究。

Application of Gail model for assessment on breast cancer risk

[Objective] To discuss the application value of the Gail model in evaluation of breast cancer risk in Huangpu District, Shanghai.[Methods] Case-control study was adopted for 156 cases of breast cancer and 198 age-matched controls. From the subjects were collected information of age, history of breast disease, family history, age at menarche, age at first birth, breast biopsy and race. Gail model was used to evaluate the risk of breast cancer for these women 5 years before.[Results] A total of 72 cases and 11 controls had high risk of breast cancer within 5 years. As the evaluation results of the diagnostic test, the sensitivity of the Gail model was 50.3 percent and the specificity 92.0 percent. The positive predictive value was 86.7 percent and the negative predictive value 64.0 percent (The Chi square was 60.09 and P value 0.000, The McNemar Chi square was 43.90 and P value 0.000). The Youden's index was 0.423. The total agreement was 70.7 percent. [Conclusion] The Gail model did not achieve the desired results for assessment of population with high risk of breast cancer. The tool needs to be further studied as a tool for screening population with high risk of breast cancer.