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We propose using B\u2010splines to model the time\u2010dependent effect of a binary time\u2010dependent covariate on a survival outcome in the presence of correlated competing risks. The proposed B\u2010splines can also help choose the best functional form for the time\u2010dependent effect. Our simulation studies demonstrate that the proposed competing risks model with B\u2010splines performs well in estimating the time\u2010dependent effect of the intervention and the penetrance function in all scenarios considered. We applied our proposed method to families carrying a pathogenic variant in\n                    <jats:italic>BRCA1<\/jats:italic>\n                    recruited through the Breast Cancer Family Registry and evaluated the time\u2010dependent effects of risk\u2010reducing salpingo\u2010oophorectomy on breast cancer risk in the presence of ovarian cancer and death from other causes as competing events. We found that the B\u2010splines model better captured the changes in the association between the intervention and breast cancer over time and provided better predictive ability than alternative parametric models, such as the permanent exposure model and the Cox and Oakes model. Our results indicate that risk\u2010reducing salpingo\u2010oophorectomy has a significant protective effect on breast cancer incidence over the follow\u2010up period.\n                  <\/jats:p>","DOI":"10.1002\/sim.70527","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T13:41:23Z","timestamp":1775569283000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flexible Modeling of Time\u2010Dependent Covariate Effects in Survival Models With Correlated Competing Risks: Application to the Evaluation of Risk\u2010Reducing Salpingo\u2010Oophorectomy in Women With\n                    <scp>\n                      <i>BRCA1<\/i>\n                    <\/scp>\n                    Pathogenic Variants"],"prefix":"10.1002","volume":"45","author":[{"given":"Seungwoo","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry Western University  London Ontario Canada"},{"name":"Maternal\u2010Infant Care Research Centre Mount Sinai Hospital  Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5741-9812","authenticated-orcid":false,"given":"Laurent","family":"Briollais","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute Mount Sinai Hospital  Toronto Canada"},{"name":"Biostatistics, Dalla Lana School of Public Health University of Toronto  Toronto Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun\u2010Hee","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry Western University  London Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"BCFR","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"145","article-title":"Hereditary Breast Cancer: Clinical, Pathological and Molecular Characteristics","volume":"8","author":"Larsen M. J.","year":"2014","journal-title":"Breast Cancer (Auckl.)"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ogc.2017.10.011"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.03.6772"},{"key":"e_1_2_10_5_1","first-page":"1993","volume-title":"GeneReviews","author":"Petrucelli N.","year":"1998"},{"issue":"5","key":"e_1_2_10_6_1","first-page":"467","article-title":"The Lifetime Risks of Breast Cancer in Ashkenazi Jewish Carriers of BRCA1 and BRCA2 Mutations","volume":"10","author":"Satagopan J. M.","year":"2001","journal-title":"Cancer Epidemiology, Biomarkers & Prevention"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/09622802211008945"},{"issue":"4","key":"e_1_2_10_8_1","first-page":"585","article-title":"Association of Risk\u2010Reducing Salpingo Oophorectomy With Breast Cancer Risk in Women With BRCA1 and BRCA2 Pathogenic Variants","volume":"7","author":"Choi Y. 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