PREDICT: a new UK prognostic model that predicts survival following surgery for invasive breast cancer: www.predict.nhs.uk
To assist in deciding the best combination of chemotherapy and hormone treatment after breast cancer surgery, clinicians use specialised computer programmes to predict how much each treatment reduces cancer-specific mortality and to estimate the effect of the treatment on competing mortality. Currently, the most commonly used programme is Adjuvant!online (©2008 Adjuvant! Inc), which uses USA cancer data and does not include any information on breast screening status as the USA does not have a population-based mammographic screening programme.
Addenbrooke’s Hospital, Cambridge University Department of Oncology and the Eastern Cancer Registration and Information Centre have collaborated to develop a completely new model, based on UK data and including screen detection status, to predict survival according to treatment. This was recently published in Breast Cancer Research (PDF version). Using the Eastern Cancer Registration & Information Centre (ECRIC) dataset, information was collated for 5694 women who had surgery for invasive breast cancer in East Anglia from 1999 to 2003. Breast cancer mortality models for oestrogen receptor (ER) positive and ER negative tumours were derived from these data using Cox proportional hazards, adjusting for prognostic factors and mode of cancer detection (symptomatic versus screen-detected). An external dataset of 5468 patients from the West Midlands Cancer Intelligence Unit was used for validation.
We have developed a prognostication model for early breast cancer based on UK cancer registry data that predicts breast cancer survival following surgery for invasive breast cancer and includes mode of detection for the first time. This model is well calibrated, provides a high degree of discrimination and has been validated in a second UK patient cohort; we are planning further validation using European breast cancer cohorts. We plan to make this model, which will be named PREDICT, available to clinicians on a NHS website later in 2010. We also intend to make the workings underlying the PREDICT model freely available to breast cancer researchers to allow them to incorporate their own data, in contrast to the Adjuvant!online! programme, which is proprietary.