Three-Point Correction Factor Improves Accuracy of Framingham Risk Score in Breast Cancer Survivors

Area of Science:

• Cardiology
• Oncology
• Epidemiology

Background:

• Women with a history of breast cancer (BC) have a 2-6 times higher risk of death from cardiovascular disease (CVD) compared to those without BC.
• The Framingham Risk Score (FRS) estimates CVD risk but does not account for a prior cancer diagnosis.

Purpose of the Study:

• To assess if a BC history impacts the predictive accuracy of the FRS for CVD events.
• To determine if a modified FRS, using a correction factor, can improve CVD risk prediction in BC survivors.

Main Methods:

• Utilized the UK Biobank prospective cohort, including BC survivors and controls without BC history.
• Excluded participants with pre-existing CVD events before enrollment.
• Tracked composite CVD events over 10 years using primary care, hospital records, and death data with CVD ICD-10 codes.

Main Results:

• Included 4,808 BC survivors and 171,427 controls; BC survivors showed a >50% increased risk of CVD events (aHR=1.51).
• FRS predicted CVD in both groups, but less accurately in BC survivors (aHR 1.03 vs 1.06).
• A 3-point correction factor improved FRS predictive accuracy for BC survivors, adjusting the observed/expected ratio from 1.41 to 0.93.

Conclusions:

• The FRS significantly underestimates CVD risk in breast cancer survivors.
• A simple +3-point correction factor substantially enhances the predictive ability of the FRS for CVD events in BC survivors.
• This correction factor offers a practical tool for clinicians to better manage cardiovascular risk in this population.