|Andrea LaCroix, Ph.D
“There are many different guidelines by different organizations, and this adds a lot of confusion for women regarding their own health”, comments Dr. LaCroix. “The trial is comparing yearly screening to a personalized screening approach. The personalized breast cancer screening will provide a mammogram timeline based on a participant’s individual risk factors (age, personal and family history, genetic tests for gene mutations and variations) linked to the development of breast cancer,”she concludes.
Dr. LaCroix’s participation in the WISDOM Trial is focused on determining how screening can be improved. She presented the two sides of the breast-health screening coin. Whereas research shows that overall mortality rates have gone down, one needs to dig in deeper to understand all the moving parts in breast screening: technology – which has certainly improved — the development of new ways to treat the different stages of breast cancer, and ultimately, personal circumstances, propensity to risk factors, and age.
In presenting the controversy surrounding breast cancer screening, Dr. LaCroix mentioned that other countries in Europe — France, the Netherlands and Denmark– have just done away with any type of guideline; whereas in the UK, women between the ages of 50 and 70 can get screened as often as desired. This is just a sample of how the breast cancer screening controversy has the potential of affecting women.
In an era where treating breast cancer is pretty much “processed” – meaning same detection and treatment across the board — Dr. LaCroix suggests a change in paradigm. “We clearly need to realize that no cancer is the same, just as breast cancer is not just a single disease”.
Citing Dr. Karsten Jorgensen, “We shouldn’t treat all cancers the same way because they are not the same. Our knowledge of cancer biology tells us that breast cancer represents a spectrum of really different cases of cancer that behave in very different ways. And sadly, screening is not good at picking up those cancers that we really want to pick up.”
The idea of the Wisdom Study is to make screening for breast cancer better. Perhaps women with a higher risk of breast cancer can get screened more often than women with a lower risk. According to research presented by Dr. LaCroix, breast cancer screening:
- Has resulted in detection of smaller tumors but not reduced the incidence of metastatic disease.
- Studies we rely upon for evidence are outdated but showed a reduced risk of breast cancer mortality of 14% for women in their 50s and 33% for women in their 60s. Breast cancer screening has not shown a significant reduction in risk in women over 70.
- Can cause harms (false-positive results, biopsies, anxiety, distress, worry about breast cancer, radiation exposure).
- Has not incorporated our advances in knowledge about breast cancer biology.
The WISDOM Study is designed to test a new way! Based on the premise that there are many variables in breast cancer, the WISDOM Trial seeks to determine if personalized screening (as compared to one-size annual screening) provides:
- Equal to or better patient safety
- Less morbidity
- More acceptance by women
- Prevention enabling
- Better healthcare value
Women around the country make decisions based on the information from their screening. If the study can provide a comprehensive picture when dealing with an already difficult illness, decisions like a double mastectomy based on an abundance of caution can save patients the consequences of unnecessary surgery, for example. The Wisdom Study guiding principles are:
- No woman will be screened less aggressively than existing recommendations from major professional societies
- Minimize false positives
- Minimize interval cancers
- Minimize incidence of Stage IIB and higher disease
- Women with known deleterious mutations in hereditary breast cancer genes will be screened according to National Comprehensive Cancer Network (NCCN) guidelines
- Screening recommendations will be practical and scalable
About the Doris A. Howell Foundation:
For the past 23 years, The Doris A. Howell Foundation for Women’s Health Research has been dedicated to keeping to women we love healthy by making a long-term, positive impact on women’s health. To date, it is the premier organization advancing women’s health.
The organization does so by funding scholarships to students researching issues affecting women’s health; providing a forum for medical experts, scientists, doctors, and researchers to convey timely information on topics relevant to women’s health, and by funding research initiatives that improve the health of under-served women and increase awareness and advocacy in the community; bringing women’s health research to a full cycle. ###
Summary & Design prepared by Carolyn Northrup and revised by Carole Banka, PHD with information provided by the key note speakers.