Development and validation of a lung cancer risk prediction model for African-Americans

• Published in: Cancer prevention research (Philadelphia, Pa.) Pa.), 2008-09, Vol.1 (4), p.255-265
• Main Authors: Etzel, Carol J, Kachroo, Sumesh, Liu, Mei, D'Amelio, Anthony, Dong, Qiong, Cote, Michele L, Wenzlaff, Angela S, Hong, Waun Ki, Greisinger, Anthony J, Schwartz, Ann G, Spitz, Margaret R
• Format: Article
• Language: English
• Subjects: African Americans - statistics & numerical data; Aged; Asthma - complications; Asthma - epidemiology; Carcinoma - epidemiology; Carcinoma - etiology; Case-Control Studies; Female; Humans; Lung Neoplasms - epidemiology; Lung Neoplasms - etiology; Male; Middle Aged; Models, Statistical; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - epidemiology; Rhinitis, Allergic, Seasonal - complications; Rhinitis, Allergic, Seasonal - epidemiology; Risk Assessment; Risk Factors; Smoking - adverse effects; Smoking - epidemiology
• ISSN: 1940-6207; 1940-6215
• DOI: 10.1158/1940-6207.CAPR-08-0082

Because existing risk prediction models for lung cancer were developed in white populations, they may not be appropriate for predicting risk among African-Americans. Therefore, a need exists to construct and validate a risk prediction model for lung cancer that is specific to African-Americans. We analyzed data from 491 African-Americans with lung cancer and 497 matched African-American controls to identify specific risks and incorporate them into a multivariable risk model for lung cancer and estimate the 5-year absolute risk of lung cancer. We performed internal and external validations of the risk model using data on additional cases and controls from the same ongoing multiracial/ethnic lung cancer case-control study from which the model-building data were obtained as well as data from two different lung cancer studies in metropolitan Detroit, respectively. We also compared our African-American model with our previously developed risk prediction model for whites. The final risk model included smoking-related variables [smoking status, pack-years smoked, age at smoking cessation (former smokers), and number of years since smoking cessation (former smokers)], self-reported physician diagnoses of chronic obstructive pulmonary disease or hay fever, and exposures to asbestos or wood dusts. Our risk prediction model for African-Americans exhibited good discrimination [75% (95% confidence interval, 0.67-0.82)] for our internal data and moderate discrimination [63% (95% confidence interval, 0.57-0.69)] for the external data group, which is an improvement over the Spitz model for white subjects. Existing lung cancer prediction models may not be appropriate for predicting risk for African-Americans because (a) they were developed using white populations, (b) level of risk is different for risk factors that African-American share with whites, and (c) unique group-specific risk factors exist for African-Americans. This study developed and validated a risk prediction model for lung cancer that is specific to African-Americans and thus more precise in predicting their risks. These findings highlight the importance of conducting further ethnic-specific analyses of disease risk.