The Tyrer-Cuzick risk model: Is it effective for all races?

Area of Science:

• Oncology
• Radiology
• Public Health

Background:

• The Tyrer-Cuzick 8 (TC8) risk model is crucial for estimating breast cancer risk and guiding MRI screening eligibility.
• Current evaluations of the TC8 model have not extensively assessed its performance across diverse racial and ethnic populations.

Purpose of the Study:

• To evaluate the predictive accuracy of the TC8 risk model in a diverse urban American population.
• To identify potential disparities in breast cancer risk assessment and MRI screening recommendations among different racial and ethnic groups.

Main Methods:

• A retrospective analysis of 73,435 patients from five urban healthcare sites (2018-2022).
• Calculation of TC8 risk scores stratified by race and ethnicity.
• Statistical analyses to assess the association between TC8 scores, cancer incidence, and demographic factors.

Main Results:

• TC8 scores significantly correlate with increased breast cancer risk (OR=1.02 per percentage point increase).
• White patients had the highest TC8 scores and greatest odds of meeting the 20% MRI screening threshold.
• Black/AA and Hispanic patients were less likely to be diagnosed with cancer and less likely to meet the TC8 threshold, suggesting potential underestimation of risk.

Conclusions:

• While TC8 scores are associated with cancer risk across groups, disparities exist in model performance and threshold attainment.
• The current TC8 threshold of 20% may not be appropriate for all racial and ethnic groups, potentially leading to under-screening of minority populations.
• Potential score bias in the TC8 model could exacerbate racial disparities in breast cancer care, impacting diagnosis, mortality, and morbidity.