An epidemiological model for prediction of endometrial cancer risk in Europe

• Published in: European journal of epidemiology 2016-01, Vol.31 (1), p.51-60
• Main Authors: Hüsing, Anika, Dossus, Laure, Ferrari, Pietro, Tjønneland, Anne, Hansen, Louise, Fagherazzi, Guy, Baglietto, Laura, Schock, Helena, Chang-Claude, Jenny, Boeing, Heiner, Steffen, Annika, Trichopoulou, Antonia, Bamia, Christina, Katsoulis, Michalis, Krogh, Vittorio, Palli, Domenico, Panico, Salvatore, Onland-Moret, N. Charlotte, Peeters, Petra H., Bueno-de-Mesquita, H. Bas, Weiderpass, Elisabete, Gram, Inger T., Ardanaz, Eva, Obón-Santacana, Mireia, Navarro, Carmen, Sánchez-Cantalejo, Emilio, Etxezarreta, Nerea, Allen, Naomi E., Khaw, Kay Tee, Wareham, Nick, Rinaldi, Sabina, Romieu, Isabelle, Merritt, Melissa A., Gunter, Marc, Riboli, Elio, Kaaks, Rudolf
• Format: Article
• Language: English
• Subjects: Adult; Aged; Body Mass Index; CANCER; Cancer risk; Cardiology; Disease models; Endometrial cancer; Endometrial Neoplasms - epidemiology; Epidemiology; Europe - epidemiology; Female; Health risks; Hormone replacement therapy; Humans; Incidence; Infectious Diseases; Medical research; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Menopause; Middle Aged; Models, Biological; Nutrition; Oncology; Postmenopause; Prediction models; Predictive Value of Tests; Predisposing factors; Prevention; Prospective Studies; Public Health; Risk assessment; Risk Assessment - methods; Risk Factors; Tobacco smoking
• ISSN: 0393-2990; 1573-7284; 1573-7284
• DOI: 10.1007/s10654-015-0030-9

Endometrial cancer (EC) is the fourth most frequent cancer in women in Europe, and as its incidence is increasing, prevention strategies gain further pertinence. Risk prediction models can be a useful tool for identifying women likely to benefit from targeted prevention measures. On the basis of data from 201,811 women (mostly aged 30-65 years) including 855 incident EC cases from eight countries in the European Prospective Investigation into Cancer and Nutrition cohort, a model to predict EC was developed. A step-wise model selection process was used to select confirmed predictive epidemiologic risk factors. Piece-wise constant hazard rates in 5-year age-intervals were estimated in a cause-specific competing risks model, five-fold-cross-validation was applied for internal validation. Risk factors included in the risk prediction model were body-mass index (BMI), menopausal status, age at menarche and at menopause, oral contraceptive use, overall and by different BMI categories and overall duration of use, parity, age at first full-term pregnancy, duration of menopausal hormone therapy and smoking status (specific for pre, peri- and post-menopausal women). These variables improved the discriminating capacity to predict risk over 5 years from 71 % for a model based on age alone to 77 % (overall statistic), and the model was wellcalibrated (ratio of expected to observed cases = 0.99). Our model could be used for the identification of women at increased risk of EC in Western Europe. To achieve an EC-risk model with general validity, a large-scale cohortconsortium approach would be needed to assess and adjust for population variation.