Liz Meszaros, MDLinx | August 08, 2017
Researchers at the University of California, Davis, health system, Sacramento, CA, will conduct the Women Informed to Screen Depending on Measures of Risk (WISDOM) study to clarify whether annual mammograms are the optimal mode of screening for breast cancer, or whether a more personalized approach based on genetic makeup, family history, and risk factors may be better.
“We need better answers for screening,” said Laura Esserman, MD, MBA, professor of surgery and director, Carol Franc Buck Breast Care Center, UCSF Helen Diller Family Comprehensive Cancer Center in San Francisco, CA, who is leading the study. “There is so much controversy around screening, and women get caught in the middle. The only way we can do better is if people participate in a program like this.”
Dr. Esserman and fellow researchers are now recruiting 100,000 women throughout California, who are required to fill out an extensive online questionnaire on health and family history. They will then be randomized to either personalized screening based on risk assessment and genetic testing, or annual screening mammograms.
“We’ve learned so much about how an individual’s genes impact their cancer risk, and I think we can use that information to improve health outcomes today,” said principal investigator Alexander "Sandy" D. Borowsky, MD, professor, department of pathology and laboratory medicine, UC Davis. “Advanced sequencing technology has made this analysis fast, accurate, and inexpensive.”
Women at highest risk will receive recommendations to begin screening at an earlier age, more often, and continue until they are older. Those with the lowest risk will begin screening later, do so less frequently, and stop screening earlier.
Researchers anticipate that most subjects will fall into the lowest risk category, but none will be screened less often than recommended by the US Preventive Services Task Force guidelines.
For some patients, insurance companies will cover genetic testing costs. For those for whom this does not apply, the tests will be paid for with philanthropic funds.
Researchers will also seek to determine whether personalized screening is as safe as annual screening, and assess whether it will bring about fewer unnecessary follow-up screening, biopsies, and other procedures. According to Dr. Esserman, personalized screening may also be shown to prevent aggressive cancers through earlier detection of genetic risk.
“Also, personalized screening promotes health care value,” she concluded. “It’s time to say we need to find a way to improve quality and in a way that costs less. That’s in everyone’s best interest. More is not better. More is just more.”
WISDOM is the result of a 5-year, $14.1 million grant from the Patient-Centered Outcomes Research Institute (PCORI). It is the first study conducted through Athena Breast Health Network, a collaboration of the five University of California medical centers to drive innovation in breast cancer prevention, screening, and treatment.