Frailty Models for Familial Risk With Application to Breast Cancer

Malka Gorfine, Li Hsu, Giovanni Parmigiani

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

In evaluating familial risk for disease we have two main statistical tasks: assessing the probability of carrying an inherited genetic mutation conferring higher risk, and predicting the absolute risk of developing diseases over time for those individuals whose mutation status is known. Despite substantial progress, much remains unknown about the role of genetic and environmental risk factors, about the sources of variation in risk among families that carry high-risk mutations, and about the sources of familial aggregation beyond major Mendelian effects. These sources of heterogeneity contribute substantial variation in risk across families. In this article we present simple and efficient methods for accounting for this variation in familial risk assessment. Our methods are based on frailty models. We implemented them in the context of generalizing Mendelian models of cancer risk, and compared our approaches to others that do not consider heterogeneity across families. Our extensive simulation study demonstrates that when predicting the risk of developing a disease over time conditional on carrier status, accounting for heterogeneity results in a substantial improvement in the area under the curve of the receiver operating characteristic. On the other hand, the improvement for carriership probability estimation is more limited. We illustrate the utility of the proposed approach through the analysis of BRCA1 and BRCA2 mutation carriers in theWashington Ashkenazi Kin-Cohort Study of Breast Cancer. Supplementary materials for this article are available online.

Original languageEnglish
Pages (from-to)1205-1215
Number of pages11
JournalJournal of the American Statistical Association
Volume108
Issue number504
DOIs
StatePublished - 2013
Externally publishedYes

Funding

FundersFunder number
National Institutes of Health
National Cancer Institute5P30 CA006516-46, 1R21CA177233-01, P50CA138293, R01AG014358, P01CA53996
Susan G. Komen
Israel Science Foundation2012898

    Keywords

    • Familial risk prediction
    • Multivariate survival
    • ROC analysis
    • Risk index

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