Fung et al. Page 506

Many breast cancer–associated SNPs have been discovered. SNP risk information can potentially enhance cancer risk prediction and inform risk-based screening programs, but is more SNP more accurate? Fung and colleagues systematically examined available literature by quantifying the extent of improvement in performance offered by SNPs in breast cancer risk prediction models. SNP information improved model performance (+0.044 in AUC), despite the lack of trend between improvement and number of SNPs. Also, as the majority of risk reclassification occurred in intermediate-risk women, screening could be a two-step process where a questionnaire is first used to identify intermediate-risk individuals, followed by testing for these women only.

Withrow et al. Page 522

Using registry data, Withrow and colleagues report stable incidence rates of CNS cancers overall among U.S. children between 1998 and 2013, though statistically significant changes were reported for several subtypes. Glioma and pilocytic astrocytoma incidence rates increased by 0.77 and 0.89% per year, respectively; embryonal cancer rates decreased by 0.88% per year. The investigators estimated these changes resulted in 120 excess gliomas, 94 excess pilocytic astrocytomas, and 72 fewer embryonal CNS tumors in 2013, compared to what would be expected had rates remained stable. These modest trends could be the result of true changes in incidence, or reflect shifts in identification, reporting, and classification.

Yang et al. Page 531

Liver ultrasound is a standard surveillance test for early detection of HCC in high-risk patients. However, liver ultrasound has limited accuracy. The GALAD score is a serum biomarker-based model that predicts the probability of having HCC in patients with chronic liver disease. In the current study, Yang and colleagues showed that the performance of the GALAD score was superior to that of ultrasound. The outstanding performance of the GALAD score was confirmed in an independent multicenter U.S. cohort of early-stage HCC and cirrhosis patients, confirming the utility of the GALAD score as an excellent tool for HCC detection. The study also demonstrates that the combination of GALAD and ultrasound, termed the GALADUS score, further enhances the performance of the GALAD score.

Cronin et al. Page 539

Black women with ovarian cancer experience worse survival than white women. Receipt of guideline care improves survival, yet care may vary by race. In this study, Cronin and colleagues evaluated disparities in guideline treatment between black and white women diagnosed with ovarian cancer and ovarian cancer deaths for these women. The authors assessed four patient and provider characteristics associated with receipt of guideline care, with a focus on care from a gynecologic oncologist (GO). Race was not associated with risk of death when guideline care was included in multivariate survival models. However, black patients received less guideline care. GO consultation significantly increased receipt of guideline care. Research is needed to understand treatment perspectives for black patients and their providers to increase the receipt of guideline care and reduce survival disparities.