Aim 1: Stratify low risk invasive tumors into low vs. ultralow vs. IDLE and high risk into interval vs. screen- detected using gene expression profiling, pathology features, immune profiling in fully annotated invasive cancer data sets and validate the best predictors in a prospective California-wide screening trial.
Aim 2: Develop adjunctive assays to stratify DCIS lesions into IDLE, ultralow, moderate and high-risk DCIS breast lesions using gene expression profiling, and measures of tumor immune micro-environment in established data sets and validate using a prospective registry of 300 DCIS cases
Aim 3: Develop a model using known germline breast cancer risk variants to predict women predisposed toward ultralow and IDLE screen detected tumors, and those predisposed to interval detected breast cancers, using data from a fully annotated California-wide screening trial that includes germline and tumor profiling.