Genetic and Clinical Predictors for Breast Cancer Risk Assessment and Stratification Among Chinese Women
Background Most of the genetic variants identified from genome-wide association studies of breast cancer have not been validated in Asian women. No risk assessment model that incorporates both genetic and clinical predictors is currently available to predict breast cancer risk in this population. Me...
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Published in | JNCI : Journal of the National Cancer Institute Vol. 102; no. 13; pp. 972 - 981 |
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Main Authors | , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Cary, NC
Oxford University Press
07.07.2010
Oxford Publishing Limited (England) |
Subjects | |
Online Access | Get full text |
ISSN | 0027-8874 1460-2105 1460-2105 |
DOI | 10.1093/jnci/djq170 |
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Abstract | Background Most of the genetic variants identified from genome-wide association studies of breast cancer have not been validated in Asian women. No risk assessment model that incorporates both genetic and clinical predictors is currently available to predict breast cancer risk in this population. Methods We analyzed 12 single-nucleotide polymorphisms (SNPs) identified in recent genome-wide association studies mostly of women of European ancestry as being associated with the risk of breast cancer in 3039 case patients and 3082 control subjects who participated in the Shanghai Breast Cancer Study. All participants were interviewed in person to obtain information regarding known and suspected risk factors for breast cancer. The c statistic, a measure of discrimination ability with a value ranging from 0.5 (random classification) to 1.0 (perfect classification), was estimated to evaluate the contribution of genetic and established clinical predictors of breast cancer to a newly established risk assessment model for Chinese women. Clinical predictors included in the model were age at menarche, age at first live birth, waist-to-hip ratio, family history of breast cancer, and a previous diagnosis of benign breast disease. The utility of the models in risk stratification was evaluated by estimating the proportion of breast cancer patients in the general population that could be accounted for above a given risk threshold as predicted by the models. All statistical tests were two-sided. Results Eight SNPs (rs2046210, rs1219648, rs3817198, rs8051542, rs3803662, rs889312, rs10941679, and rs13281615), each of which reflected a genetically independent locus, were found to be associated with the risk of breast cancer. A dose–response association was observed between the risk of breast cancer and the genetic risk score, which is an aggregate measure of the effect of these eight SNPs (odds ratio for women in the highest quintile of genetic risk score vs those in the lowest = 1.85, 95% confidence interval = 1.58 to 2.18, Ptrend = 2.5 × 10−15). The genetic risk score, the waist-to-hip ratio, and a previous diagnosis of benign breast disease were the top three predictors of the risk of breast cancer, each contributing statistically significantly (P < .001) to the full risk assessment model. The model, with a c statistic of 0.6295 after adjustment for overfitting, showed promise for stratifying women into different risk groups; women in the top 30% risk group accounted for nearly 50% of the breast cancers diagnosed in the general population. Conclusion A risk assessment model that includes both genetic markers and clinical predictors may be useful to classify Asian women into relevant risk groups for cost-efficient screening and other prevention programs. |
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AbstractList | Most of the genetic variants identified from genome-wide association studies of breast cancer have not been validated in Asian women. No risk assessment model that incorporates both genetic and clinical predictors is currently available to predict breast cancer risk in this population. A risk assessment model that includes both genetic markers and clinical predictors may be useful to classify Asian women into relevant risk groups for cost-efficient screening and other prevention programs. Most of the genetic variants identified from genome-wide association studies of breast cancer have not been validated in Asian women. No risk assessment model that incorporates both genetic and clinical predictors is currently available to predict breast cancer risk in this population. We analyzed 12 single-nucleotide polymorphisms (SNPs) identified in recent genome-wide association studies mostly of women of European ancestry as being associated with the risk of breast cancer in 3039 case patients and 3082 control subjects who participated in the Shanghai Breast Cancer Study. All participants were interviewed in person to obtain information regarding known and suspected risk factors for breast cancer. The c statistic, a measure of discrimination ability with a value ranging from 0.5 (random classification) to 1.0 (perfect classification), was estimated to evaluate the contribution of genetic and established clinical predictors of breast cancer to a newly established risk assessment model for Chinese women. Clinical predictors included in the model were age at menarche, age at first live birth, waist-to-hip ratio, family history of breast cancer, and a previous diagnosis of benign breast disease. The utility of the models in risk stratification was evaluated by estimating the proportion of breast cancer patients in the general population that could be accounted for above a given risk threshold as predicted by the models. All statistical tests were two-sided. Eight SNPs (rs2046210, rs1219648, rs3817198, rs8051542, rs3803662, rs889312, rs10941679, and rs13281615), each of which reflected a genetically independent locus, were found to be associated with the risk of breast cancer. A dose-response association was observed between the risk of breast cancer and the genetic risk score, which is an aggregate measure of the effect of these eight SNPs (odds ratio for women in the highest quintile of genetic risk score vs those in the lowest = 1.85, 95% confidence interval = 1.58 to 2.18, P(trend) = 2.5 x 10(-15)). The genetic risk score, the waist-to-hip ratio, and a previous diagnosis of benign breast disease were the top three predictors of the risk of breast cancer, each contributing statistically significantly (P < .001) to the full risk assessment model. The model, with a c statistic of 0.6295 after adjustment for overfitting, showed promise for stratifying women into different risk groups; women in the top 30% risk group accounted for nearly 50% of the breast cancers diagnosed in the general population. A risk assessment model that includes both genetic markers and clinical predictors may be useful to classify Asian women into relevant risk groups for cost-efficient screening and other prevention programs. Most of the genetic variants identified from genome-wide association studies of breast cancer have not been validated in Asian women. No risk assessment model that incorporates both genetic and clinical predictors is currently available to predict breast cancer risk in this population.BACKGROUNDMost of the genetic variants identified from genome-wide association studies of breast cancer have not been validated in Asian women. No risk assessment model that incorporates both genetic and clinical predictors is currently available to predict breast cancer risk in this population.We analyzed 12 single-nucleotide polymorphisms (SNPs) identified in recent genome-wide association studies mostly of women of European ancestry as being associated with the risk of breast cancer in 3039 case patients and 3082 control subjects who participated in the Shanghai Breast Cancer Study. All participants were interviewed in person to obtain information regarding known and suspected risk factors for breast cancer. The c statistic, a measure of discrimination ability with a value ranging from 0.5 (random classification) to 1.0 (perfect classification), was estimated to evaluate the contribution of genetic and established clinical predictors of breast cancer to a newly established risk assessment model for Chinese women. Clinical predictors included in the model were age at menarche, age at first live birth, waist-to-hip ratio, family history of breast cancer, and a previous diagnosis of benign breast disease. The utility of the models in risk stratification was evaluated by estimating the proportion of breast cancer patients in the general population that could be accounted for above a given risk threshold as predicted by the models. All statistical tests were two-sided.METHODSWe analyzed 12 single-nucleotide polymorphisms (SNPs) identified in recent genome-wide association studies mostly of women of European ancestry as being associated with the risk of breast cancer in 3039 case patients and 3082 control subjects who participated in the Shanghai Breast Cancer Study. All participants were interviewed in person to obtain information regarding known and suspected risk factors for breast cancer. The c statistic, a measure of discrimination ability with a value ranging from 0.5 (random classification) to 1.0 (perfect classification), was estimated to evaluate the contribution of genetic and established clinical predictors of breast cancer to a newly established risk assessment model for Chinese women. Clinical predictors included in the model were age at menarche, age at first live birth, waist-to-hip ratio, family history of breast cancer, and a previous diagnosis of benign breast disease. The utility of the models in risk stratification was evaluated by estimating the proportion of breast cancer patients in the general population that could be accounted for above a given risk threshold as predicted by the models. All statistical tests were two-sided.Eight SNPs (rs2046210, rs1219648, rs3817198, rs8051542, rs3803662, rs889312, rs10941679, and rs13281615), each of which reflected a genetically independent locus, were found to be associated with the risk of breast cancer. A dose-response association was observed between the risk of breast cancer and the genetic risk score, which is an aggregate measure of the effect of these eight SNPs (odds ratio for women in the highest quintile of genetic risk score vs those in the lowest = 1.85, 95% confidence interval = 1.58 to 2.18, P(trend) = 2.5 x 10(-15)). The genetic risk score, the waist-to-hip ratio, and a previous diagnosis of benign breast disease were the top three predictors of the risk of breast cancer, each contributing statistically significantly (P < .001) to the full risk assessment model. The model, with a c statistic of 0.6295 after adjustment for overfitting, showed promise for stratifying women into different risk groups; women in the top 30% risk group accounted for nearly 50% of the breast cancers diagnosed in the general population.RESULTSEight SNPs (rs2046210, rs1219648, rs3817198, rs8051542, rs3803662, rs889312, rs10941679, and rs13281615), each of which reflected a genetically independent locus, were found to be associated with the risk of breast cancer. A dose-response association was observed between the risk of breast cancer and the genetic risk score, which is an aggregate measure of the effect of these eight SNPs (odds ratio for women in the highest quintile of genetic risk score vs those in the lowest = 1.85, 95% confidence interval = 1.58 to 2.18, P(trend) = 2.5 x 10(-15)). The genetic risk score, the waist-to-hip ratio, and a previous diagnosis of benign breast disease were the top three predictors of the risk of breast cancer, each contributing statistically significantly (P < .001) to the full risk assessment model. The model, with a c statistic of 0.6295 after adjustment for overfitting, showed promise for stratifying women into different risk groups; women in the top 30% risk group accounted for nearly 50% of the breast cancers diagnosed in the general population.A risk assessment model that includes both genetic markers and clinical predictors may be useful to classify Asian women into relevant risk groups for cost-efficient screening and other prevention programs.CONCLUSIONA risk assessment model that includes both genetic markers and clinical predictors may be useful to classify Asian women into relevant risk groups for cost-efficient screening and other prevention programs. Background Most of the genetic variants identified from genome-wide association studies of breast cancer have not been validated in Asian women. No risk assessment model that incorporates both genetic and clinical predictors is currently available to predict breast cancer risk in this population. Methods We analyzed 12 single-nucleotide polymorphisms (SNPs) identified in recent genome-wide association studies mostly of women of European ancestry as being associated with the risk of breast cancer in 3039 case patients and 3082 control subjects who participated in the Shanghai Breast Cancer Study. All participants were interviewed in person to obtain information regarding known and suspected risk factors for breast cancer. The c statistic, a measure of discrimination ability with a value ranging from 0.5 (random classification) to 1.0 (perfect classification), was estimated to evaluate the contribution of genetic and established clinical predictors of breast cancer to a newly established risk assessment model for Chinese women. Clinical predictors included in the model were age at menarche, age at first live birth, waist-to-hip ratio, family history of breast cancer, and a previous diagnosis of benign breast disease. The utility of the models in risk stratification was evaluated by estimating the proportion of breast cancer patients in the general population that could be accounted for above a given risk threshold as predicted by the models. All statistical tests were two-sided. Results Eight SNPs (rs2046210, rs1219648, rs3817198, rs8051542, rs3803662, rs889312, rs10941679, and rs13281615), each of which reflected a genetically independent locus, were found to be associated with the risk of breast cancer. A dose–response association was observed between the risk of breast cancer and the genetic risk score, which is an aggregate measure of the effect of these eight SNPs (odds ratio for women in the highest quintile of genetic risk score vs those in the lowest = 1.85, 95% confidence interval = 1.58 to 2.18, Ptrend = 2.5 × 10−15). The genetic risk score, the waist-to-hip ratio, and a previous diagnosis of benign breast disease were the top three predictors of the risk of breast cancer, each contributing statistically significantly (P < .001) to the full risk assessment model. The model, with a c statistic of 0.6295 after adjustment for overfitting, showed promise for stratifying women into different risk groups; women in the top 30% risk group accounted for nearly 50% of the breast cancers diagnosed in the general population. Conclusion A risk assessment model that includes both genetic markers and clinical predictors may be useful to classify Asian women into relevant risk groups for cost-efficient screening and other prevention programs. Background Most of the genetic variants identified from genome-wide association studies of breast cancer have not been validated in Asian women. No risk assessment model that incorporates both genetic and clinical predictors is currently available to predict breast cancer risk in this population. Methods We analyzed 12 single-nucleotide polymorphisms (SNPs) identified in recent genome-wide association studies mostly of women of European ancestry as being associated with the risk of breast cancer in 3039 case patients and 3082 control subjects who participated in the Shanghai Breast Cancer Study. All participants were interviewed in person to obtain information regarding known and suspected risk factors for breast cancer. The c statistic, a measure of discrimination ability with a value ranging from 0.5 (random classification) to 1.0 (perfect classification), was estimated to evaluate the contribution of genetic and established clinical predictors of breast cancer to a newly established risk assessment model for Chinese women. Clinical predictors included in the model were age at menarche, age at first live birth, waist-to-hip ratio, family history of breast cancer, and a previous diagnosis of benign breast disease. The utility of the models in risk stratification was evaluated by estimating the proportion of breast cancer patients in the general population that could be accounted for above a given risk threshold as predicted by the models. All statistical tests were two-sided. Results Eight SNPs (rs2046210, rs1219648, rs3817198, rs8051542, rs3803662, rs889312, rs10941679, and rs13281615), each of which reflected a genetically independent locus, were found to be associated with the risk of breast cancer. A dose-response association was observed between the risk of breast cancer and the genetic risk score, which is an aggregate measure of the effect of these eight SNPs (odds ratio for women in the highest quintile of genetic risk score vs those in the lowest = 1.85, 95% confidence interval = 1.58 to 2.18, P sub(trend) = 2.5 10 super(-15)). The genetic risk score, the waist-to-hip ratio, and a previous diagnosis of benign breast disease were the top three predictors of the risk of breast cancer, each contributing statistically significantly (P < .001) to the full risk assessment model. The model, with a c statistic of 0.6295 after adjustment for overfitting, showed promise for stratifying women into different risk groups; women in the top 30% risk group accounted for nearly 50% of the breast cancers diagnosed in the general population. Conclusion A risk assessment model that includes both genetic markers and clinical predictors may be useful to classify Asian women into relevant risk groups for cost-efficient screening and other prevention programs. |
Author | Shyr, Yu Li, Chun Cai, Qiuyin Lu, Wei Zheng, Wei Shu, Xiao-Ou Wen, Wanqing Long, Jirong Zheng, Ying Li, Guoliang Gu, Kai Gao, Yu-Tang |
AuthorAffiliation | Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) |
AuthorAffiliation_xml | – name: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) |
Author_xml | – sequence: 1 givenname: Wei surname: Zheng fullname: Zheng, Wei email: wei.zheng@vanderbilt.edu organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) – sequence: 2 givenname: Wanqing surname: Wen fullname: Wen, Wanqing organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) – sequence: 3 givenname: Yu-Tang surname: Gao fullname: Gao, Yu-Tang organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) – sequence: 4 givenname: Yu surname: Shyr fullname: Shyr, Yu organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) – sequence: 5 givenname: Ying surname: Zheng fullname: Zheng, Ying email: wei.zheng@vanderbilt.edu organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) – sequence: 6 givenname: Jirong surname: Long fullname: Long, Jirong organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) – sequence: 7 givenname: Guoliang surname: Li fullname: Li, Guoliang organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) – sequence: 8 givenname: Chun surname: Li fullname: Li, Chun organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) – sequence: 9 givenname: Kai surname: Gu fullname: Gu, Kai organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) – sequence: 10 givenname: Qiuyin surname: Cai fullname: Cai, Qiuyin organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) – sequence: 11 givenname: Xiao-Ou surname: Shu fullname: Shu, Xiao-Ou organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) – sequence: 12 givenname: Wei surname: Lu fullname: Lu, Wei organization: Affiliations of authors: Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center (WZ, WW, JL, GL, QC, X-OS) and Department of Biostatistics (YS, CL), Vanderbilt University School of Medicine, Nashville, TN; Department of Epidemiology, Shanghai Cancer Institute, Shanghai, China (Y-TG); Shanghai Center for Disease Prevention and Control, Shanghai Institute of Preventive Medicine, Shanghai, China (YZ, KG, WL) |
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Copyright | 2015 INIST-CNRS Copyright Oxford Publishing Limited(England) Jul 7, 2010 The Author 2010. Published by Oxford University Press. 2010 |
Copyright_xml | – notice: 2015 INIST-CNRS – notice: Copyright Oxford Publishing Limited(England) Jul 7, 2010 – notice: The Author 2010. Published by Oxford University Press. 2010 |
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Keywords | Human Breast disease Asiatic Genotype Breast cancer Malignant tumor Epidemiology Mammary gland diseases Cancerology Statistical model Risk factor Genetics Adult Chinese Female Single nucleotide polymorphism Public health Cancer |
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Snippet | Background Most of the genetic variants identified from genome-wide association studies of breast cancer have not been validated in Asian women. No risk... Most of the genetic variants identified from genome-wide association studies of breast cancer have not been validated in Asian women. No risk assessment model... |
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SubjectTerms | Adult Age of Onset Asian Continental Ancestry Group - genetics Asian Continental Ancestry Group - statistics & numerical data Asian people Biological and medical sciences Breast cancer Breast Neoplasms - epidemiology Breast Neoplasms - etiology Breast Neoplasms - genetics Case-Control Studies China - epidemiology European Continental Ancestry Group - genetics Female Genetic diversity Genetic Predisposition to Disease Genome-Wide Association Study Genomics Genotype Gynecology. Andrology. Obstetrics Health risk assessment Humans Live Birth Mammary gland diseases Medical sciences Menarche Middle Aged Models, Statistical Polymorphism, Single Nucleotide Predictive Value of Tests Risk Assessment Risk Factors Tumors Waist-Hip Ratio Women |
Title | Genetic and Clinical Predictors for Breast Cancer Risk Assessment and Stratification Among Chinese Women |
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