TY - JOUR
T1 - Validation of the Harvard Cancer Risk Index
T2 - A prediction tool for individual cancer risk
AU - Kim, Daniel J.
AU - Rockhill, Beverly
AU - Colditz, Graham A.
N1 - Funding Information:
We are grateful to Diane Feskanich, Catherine Berkey, Al Wing, and Karen Corsano at the Channing Laboratory for their technical assistance. The work presented in this article was supported by the Harvey V. Fineberg Fellowship through the Harvard Center for Cancer Prevention and a Canadian Cancer Society Post MD Research Fellowship through the National Cancer Institute of Canada (Daniel Kim).
PY - 2004/4
Y1 - 2004/4
N2 - Objective Risk appraisal tools are increasingly being used in the clinical setting to estimate individual's risks of developing and dying from diseases. The Harvard Cancer Risk Index is one such tool constructed to predict the risks of individuals, aged 40 and above, for developing the leading types of cancer in U.S. men and women relative to the general population. To date, the Risk Index has not been prospectively validated. Study design and setting Over a period of 10 years' follow-up in the Nurses' Health Study and the Health Professionals' Follow-up Study, age-standardized incidence ratios for cancer of the ovary, colon, and pancreas were calculated for the Risk Index's relative risk categories to assess goodness of fit for risk prediction at the aggregate level. Age-adjusted concordance statistics were determined as measures of discriminatory accuracy at the individual level. Results The Risk Index was well calibrated with observed relative risks across categories for ovarian and colon cancer in women and pancreatic cancer in men, while it performed moderately for colon cancer in men. Discriminatory accuracy was modest for ovarian cancer (concordance statistic of 0.72) and colon cancer in men and women (concordance statistics of 0.71 and 0.67 respectively). Conclusion The results of this prospective validation provide evidence for the validity of the Risk Index in predicting individual's risks of cancers, and thereby offer support for future applications of this risk appraisal tool.
AB - Objective Risk appraisal tools are increasingly being used in the clinical setting to estimate individual's risks of developing and dying from diseases. The Harvard Cancer Risk Index is one such tool constructed to predict the risks of individuals, aged 40 and above, for developing the leading types of cancer in U.S. men and women relative to the general population. To date, the Risk Index has not been prospectively validated. Study design and setting Over a period of 10 years' follow-up in the Nurses' Health Study and the Health Professionals' Follow-up Study, age-standardized incidence ratios for cancer of the ovary, colon, and pancreas were calculated for the Risk Index's relative risk categories to assess goodness of fit for risk prediction at the aggregate level. Age-adjusted concordance statistics were determined as measures of discriminatory accuracy at the individual level. Results The Risk Index was well calibrated with observed relative risks across categories for ovarian and colon cancer in women and pancreatic cancer in men, while it performed moderately for colon cancer in men. Discriminatory accuracy was modest for ovarian cancer (concordance statistic of 0.72) and colon cancer in men and women (concordance statistics of 0.71 and 0.67 respectively). Conclusion The results of this prospective validation provide evidence for the validity of the Risk Index in predicting individual's risks of cancers, and thereby offer support for future applications of this risk appraisal tool.
KW - Behavioral risk factors
KW - Cancer
KW - Primary prevention
KW - Risk appraisal
KW - Risk prediction
KW - Validation
UR - http://www.scopus.com/inward/record.url?scp=2342469975&partnerID=8YFLogxK
U2 - 10.1016/j.jclinepi.2003.08.013
DO - 10.1016/j.jclinepi.2003.08.013
M3 - Article
C2 - 15135833
AN - SCOPUS:2342469975
SN - 0895-4356
VL - 57
SP - 332
EP - 340
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 4
ER -