You Can Help Design Sensible, Effective Breast Cancer Screening

Hey all, this is good and you might want to join and partake in this study!

By Laura Esserman
Yet another set of mammography screening guidelines was released recently, but they do little to clear up the confusion about how often and at what age women should screen for breast cancer.

Women are caught in the middle of the dizzying array of guidelines — each with different recommendations. Amazingly, they are all based on the same information — data gleaned from trials conducted 30 and 40 years ago, before we really knew much about breast cancer. The trials assumed that cancer was one disease and that all women should be screened in the same way. But we know that breast cancer is not one disease. Rather, it is many with a wide range of behaviors, from indolent to aggressive.

What we need are large-scale studies, based on what we know about cancer now, to help guide women and their practitioners on screening. By tailoring screening to each individual’s risk, it may be possible to increase the benefits (early detection and less life- altering treatment, improved survival) and reduce harms (excess recalls, biopsies, overtreatment after detection of ultra-low risk tumors) of screening and improve upon the one-size-fits-all approach.

But first, we need to test a personalized approach, usher in new models and generate the data to inform discussions about how best to screen. It is time to stop debating and start focusing on how to improve breast cancer screening.
Fortunately, there is an ongoing study that can help us learn how to screen better. The Women Informed to Screen Depending On Measures of risk (WIS-DOM) study, conducted by the five University of California medical centers, in partnership with Sanford Health system in the Midwest, will look at whether personalized screening is as safe as and more effective than annual mammography.

In the study of approximately 100,000 women, each woman’s risk of developing breast cancer will be assessed. Women can be assigned to, or choose, annual screening or personalized screening. Those at higher risk will be screened more often than those at lower risk. More for those that need it, fewer for whom the benefit is less. The personalized approach applies everything we know about risk and biology to determine when to start and stop screening, how often to screen and with what imaging technology.

The five-year study is open to all women, ages 40 to 74, living in the California and Sanford Health regions. It offers women the opportunity not only to learn about their own risk but also to help design better screening guidelines. A customized approach to treatment and prevention may very well have better outcomes at lower cost. In an era where the cost of health care is of national concern, better value should be welcomed by patients, physicians, clinics, insurers and health policymakers.

To date, 5,000 women have joined the WISDOM study, which is supported by a research institute established by the Affordable Care Act to fill knowledge gaps on critical medical issues. If you are a woman age 40 to 74, then join us, share your wisdom and be one of the 100,000 who helps teach us how to increase the benefits and reduce the harms of screening.

Dr. Laura Esserman, a professor of surgery and radiology at UCSF is leading the WISDOM study. For information go to http://wisdomstudy.org.