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The B-S2CALED Score's Utility in Predicting Stroke Risk in Breast Cancer Patients with Atrial Fibrillation.

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|November 27, 2025
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Summary

A new breast cancer (BC)-specific score, B-S2CALED, effectively predicts ischemic stroke (IS) risk in BC patients with atrial fibrillation (AF). This score outperforms the standard CHA2DS2-VASc in identifying patients at high risk for thromboembolic events.

Keywords:
arrhythmiabreast cancerguidelinesrisk predictionscreeningthrombosis

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Area of Science:

  • Oncology
  • Cardiology
  • Medical Informatics

Background:

  • Breast cancer (BC) patients face elevated risks of atrial fibrillation (AF) and ischemic stroke (IS).
  • Existing IS risk scores lack validation in cancer populations and do not incorporate cancer-specific factors.
  • Current clinical guidelines lack tailored management strategies for IS risk in BC patients with AF.

Purpose of the Study:

  • To develop and validate a novel risk prediction score for IS in BC patients diagnosed with AF.
  • To create a tool that addresses the limitations of current scores in the cancer population.

Main Methods:

  • Utilized data from UH Seidman Cancer Center (derivation/internal validation) and MCG Cancer Center (external validation).
  • Included adult patients (≥18 years) with DCIS or stages I-IV BC who developed AF post-diagnosis.
  • Employed LASSO Cox regression for variable selection, cubic splines for continuous predictors, and multivariable hazards to formulate the B-S2CALED score.
  • Assessed discrimination using concordance index (C-index) and net reclassification improvement (NRI) against CHA2DS2-VASc.

Main Results:

  • In internal validation (n=935), B-S2CALED achieved a C-index of 0.64 (vs. 0.54 for CHA2DS2-VASc) with an NRI of 0.188.
  • In external validation (n=95), B-S2CALED showed a C-index of 0.77 (vs. 0.53 for CHA2DS2-VASc) with an NRI of 0.563.
  • The B-S2CALED score demonstrated superior predictive performance for thromboembolic events in both cohorts.

Conclusions:

  • The developed BC-specific B-S2CALED score significantly outperforms the CHA2DS2-VASc score in predicting IS risk among BC patients with AF.
  • Further validation in larger patient cohorts is recommended prior to widespread clinical implementation.