ArticleCancer prevention research (Philadelphia, Pa.)2026
Validation of a Colorectal Cancer Risk Prediction Model in US Black Women.
Article in Cancer prevention research (Philadelphia, Pa.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
The National Cancer Institute's Colorectal Cancer Risk Assessment Tool (NCI-CCRAT), an absolute risk prediction model, was developed using data from US White men and women. The model's performance has not been assessed for Black Americans, the US racial/ethnic group with the highest colorectal cancer incidence. We externally validated the NCI-CCRAT using data from 53,324 Black Women's Health Study (BWHS) participants aged 40 to 84 years. We predicted 5-year absolute risks using data from 2001 to 2015 in three 5-year prediction periods: 2001 to 2005, 2006 to 2010, and 2011 to 2015. To assess model performance, we computed calibration (expected over observed colorectal cancer cases, E/O) and discriminatory accuracy [area under the receiver operating curve (AUC)]. During follow-up, 433 BWHS participants developed colorectal cancer. Based on the NCI-CCRAT, 579 colorectal cancer cases were expected [E/O = 1.34; 95% confidence interval (CI), 1.22-1.47]. The NCI-CCRAT was well-calibrated in the first 5-year prediction period (2001-2005 E/O = 1.10; 95% CI, 0.94-1.29), but statistically significantly overestimated risk in later periods. We estimated discriminatory accuracy only for the 2001 to 2005 prediction period (151 colorectal cancer cases) and obtained an age-adjusted AUC = 0.62 (95% CI, 0.57-0.66). Associations of vigorous physical activity, aspirin/NSAID use, vegetable intake, and body mass index with colorectal cancer risk were weaker in the BWHS than in the studies used to develop the NCI-CCRAT. The NCI-CCRAT significantly overestimated the number of colorectal cancer cases in BWHS participants, possibly due to population-specific differences in associations of key colorectal cancer risk factors. This suggests that future research needs to determine important predictors of colorectal cancer risk in Black Americans and to develop a colorectal cancer prediction model for Black women. PREVENTION RELEVANCE: We found that the NCI's Colorectal Cancer Risk Assessment Tool overestimated the overall number of colorectal cancer cases by 34% in a cohort of Black women, suggesting that future research needs to determine important predictors of colorectal cancer risk in Black Americans and to develop a colorectal cancer prediction model for Black women.
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