Elizabeth Fernandez, UC San Francisco
A novel UC San Francisco study that aims to transform breast cancer screening is expanding to reach women as young as 30, with the intention of including thousands of women who could be at higher risk of developing aggressive cancer.
The expanded study, known as WISDOM 2.0, is testing a personalized approach that replaces the standard annual mammogram with recommended screening schedules based on personal risk factors, such as age, genetics, lifestyle, health history and breast density. It expects to start enrolling women ages 30 to 40 as early as this summer, while also expanding its genetic testing capacity for the most aggressive cancers.
“We want to test smarter, not test more,” said Laura Esserman, M.D., MBA, director of the UCSF Breast Care Center and the study’s leader. “Over the last 30 years, we’ve learned that breast cancer is not just one disease. We’ve also learned that women’s risks for developing each type of breast cancer varies.”
Esserman launched the WISDOM study in 2016 with the goal of leveraging the best tools in modern medicine to determine who is at highest risk and may benefit from more screening, who can safely have fewer screenings, and whether a personalized approach leads to better breast cancer outcomes than standard screening.
While breast cancer deaths have declined in recent years, it remains the second-leading cause of cancer death for women, with more than 40,000 women dying from the disease each year. Women of color have disproportionately higher rates of the most aggressive breast cancers and also higher breast cancer mortality rates. Yet most screening guidelines are the same for everyone: begin annual mammograms at age 40 and continue until 75.
“When it comes to breast screening, one size may not fit all,” said Esserman, who co-leads the UCSF Breast Oncology Program.
“We know that Black women have more aggressive cancers and higher mortality rates from cancer than others, and we are working to change that,” she said. “Reducing health disparities is part of our mission so that someday all women can live longer, healthier lives.”
Catching aggressive cases early
Since it began, WISDOM has enrolled more than 50,000 participants nationwide — a number the researchers hope to grow to 72,000 by the end of this year. Of those, more than 20,000 women have learned their genetic risk for breast cancer and 1,500 women have learned that they are at elevated risk. More than 300 women have been treated for cancer.
As those numbers reflect, the vast majority of women are at low risk and may not need screening until they are in their 50s. But for the small percentage of women at very high risk for cancer at a young age, early screening can be critical. The goal is to apply the most current knowledge to provide a management strategy that is optimal for every woman, and to learn and keep improving.
While the personalized approach aims to benefit every patient, it’s especially important for the small group of women who have an inherited mutation that gives them an 80 percent chance of developing cancer. Importantly, the hallmark of these cases is the development of aggressive cancers at younger ages, before screening is usually started.
In WISDOM 1.0, researchers found that most of the women with these mutations did not have a family history of the disease. Now, Esserman said, we have the tools to test participants’ DNA for those mutations, so there is no reason not to start that one-time test earlier. We also have tools to predict slower-growing, hormone-driven cancers, for which we have very effective ways to reduce the chance of ever developing cancer. Those tools will not only help the women enrolled in WISDOM but also, if shown to be more effective than current screening, could change the guidelines on how we assess breast cancer risk overall.”
“First, though, WISDOM will need to show that a personalized approach is more effective in preventing missed diagnoses and improving breast cancer outcomes than the current standard of care,” Esserman said. “If it does, it could fundamentally change the way we prevent, screen, and treat breast cancer, potentially reducing the number of women who ever get a diagnosis and improving the quality of life for all.”