PREDICT Model: Breast Cancer SurvivalUse the interactive PREDICT tool to estimate breast cancer survival and the benefits of hormone therapy, chemotherapy and trastuzumab.
Welcome to PREDICT, an online prognostication and treatment benefit tool designed to help clinicians and patients make informed decisions about treatment following breast cancer surgery. The survival estimates, presented both with and without adjuvant therapy (hormone therapy, chemotherapy and trastuzumab), are provided for 5 and 10 years following surgery. Development of the model was a collaborative project between the Cambridge Breast Unit, University of Cambridge Department of Oncology and the Eastern Cancer Information and Registration Centre (ECRIC) and was supported by an unrestricted educational grant from Pfizer Limited.
The model was derived from cancer registry information on 5,694 women treated in East Anglia from 1999-2003. Breast cancer mortality models for ER positive and ER negative tumours were constructed using Cox proportional hazards, adjusted for known prognostic factors and mode of detection (symptomatic versus screen-detected). The model was validated in two datasets from the West Midlands Cancer Intelligence Unit and British Columbia. The survival estimates for an individual patient are based on the average co morbidity for women with breast cancer of a similar age. Further information about the model is provided in a paper published in Breast Cancer Research in January 2010.
We also validated PREDICT using the British Columbia dataset previously used for a validation of Adjuvant! Predict provided overall and breast cancer specific survival estimates that were at least as accurate as estimates from Adjuvant! The results of this validation were published in the European Journal of Surgical Oncology.
The model was updated in October 2011 to include HER2 status. Estimates for the prognostic effect of HER2 status were based on analysis of 10,179 cases collected by the Breast Cancer Association Consortium (BCAC). A validation of the new model in the British Columbia dataset was published in the British Journal of Cancer. This showed that inclusion of HER2 status has improved breast cancer-specific mortality estimates, especially in HER2 positive patients. The benefit of trastuzumab is based on the relative risk reduction of 31 per cent in mortality up to five years in published trials.
More recently we have added KI67 status to the model. The prognostic effect of KI67 was taken from published data showing that ER positive tumours that express KI67 are associated with a 30 per cent poorer relative survival. The model including KI67 has not yet been externally validated.
The model is easy to use following data entry for an individual patient including patient age, tumour size, tumour grade, number of positive nodes, ER status, HER2 status, KI67 status and mode of detection. Survival estimates, with and without adjuvant therapy, are presented in visual and text formats. Treatment benefits for hormone therapy and chemotherapy are calculated by applying relative risk reductions from the Oxford overview to the breast cancer specific mortality. Predicted mortality reductions are available for both second generation (anthracycline-containing, >4 cycles or equivalent) and third generation (taxane-containing) chemotherapy regimens. The Cambridge Breast Unit (UK) uses the absolute 10-year survival benefit from chemotherapy to guide decision making for adjuvant chemotherapy as follows: <3% no chemotherapy; 3-5% chemotherapy discussed as a possible option; >5% chemotherapy recommended. The relative risk reduction for hormone therapy is based on 5 years of tamoxifen.
We welcome any feedback you may have about PREDICT. If there are features you would like to have added to the model please let us know by emailing us at firstname.lastname@example.orgUseful links