Clinical Epidemiology and Global Health · Aug 29, 2026
Deficit-index-derived biological age versus chronological age for discriminating breast cancer risk among Indonesian women: A hospital-based case-control study
By Nindrea RD, Novera M, Syahrial et al.
Introduction Breast cancer is a major public health problem among Indonesian women. Chronological age is widely used in risk assessment but may not capture biological variation from reproductive, familial, lifestyle, anthropometric, and dietary factors. This study compared deficit-index-derived biological age with chronological age for discriminating breast cancer status, and assessed its relationship to a conventional risk score. Materials and Methods A hospital-based case-control study was conducted in West Sumatra, Indonesia (June–August 2025), including 682 histopathologically confirmed cases and 682 age-matched controls. A deficit index was built from candidate risk factors, the regression of log-transformed deficit index on chronological age was estimated using controls only, to avoid outcome contamination. Discrimination was assessed by AUC (DeLong test for comparisons), adjusted associations used multivariable logistic regression, with bootstrap internal validation. Results Based on 12 deficits, mean biological age was 64.14±14.34 years versus chronological age 49.57±10.12 years (gap 14.57). Biological age discriminated cases from controls better than chronological age (AUC 0.776 vs 0.509). Combining both gave only a marginal gain (AUC 0.783; P=0.011). A conventional risk score from the same variables discriminated significantly better than biological age (AUC 0.813; P<0.001), consistent with the index aggregating established risk factors. Conclusion Deficit-index-derived biological age discriminated breast cancer status better than chronological age but did not exceed a conventional risk score from the same variables. It is best interpreted as an integrative summary of established risk, with value for risk communication pending prospective and external validation.