Background: The Tyrer-Cuzick (TC) model is a breast cancer risk assessment tool that provides women with their risk of developing breast cancer based on genetic and personal factors. The most recent version of the TC model, TC8, is the first version to include breast density as a risk factor for breast cancer. Breast density is known to vary by race, leading to questions regarding the TC8 model’s performance across races. Furthermore, recent findings have suggested that the TC8 model underestimates breast cancer risk in Black women. This review sought to summarize the current body of knowledge surrounding TC8 model validation across races and suggest future directions of study.
Findings: A review of the current literature yielded only four main studies validating the TC8 model. These studies found the TC8 model’s performance to be adequate based on ratios of observed to expected breast cancer cases, Area Under the Curve (AUC) values, and c-index values. However, Black women were either underrepresented or not represented in all four studies. In fact, Black women represented less than five percent of the patient population in the studies identified. No studies validating the TC8 model in sufficiently diverse patient populations were identified.
Several studies assessing the performance of the TC7 model combined with breast density, a model similar to the TC8 model, were also identified during review of the literature. These studies found that the addition of breast density to the TC7 model improved its performance, although Black women were again underrepresented in these studies.
Conclusion: There is a lack of evidence regarding the TC8 model’s performance in Black women. Further studies should be conducted to assess and validate the TC8 model in diverse populations that are representative of the overall United States population to ensure that Black women are receiving accurate breast cancer risk assessment.
Tyrer-Cuzick, Breast cancer, Risk model, Risk assessment, Breast density, Race, Disparities