Beyond One-Size-Fits-All: Exploring Personalised Breast Cancer Screening Strategies
I have recently become aware of the fascinating WISDOM study by Dr. Laura Esserman and her dedicated team at the University of California, San Francisco. As a healthcare professional deeply invested in advancing medical practices, I eagerly anticipate the outcomes of this groundbreaking research. For many years, I have been an advocate for personalised medicine and individualised breast screening approaches, recognising the potential benefits they could bring to patient care and outcomes.
It's crucial to understand that when it comes to breast cancer risk, women are not a homogeneous group. Each individual carries a unique risk profile influenced by various factors. Currently, in New Zealand, our breast screening program follows a standardised approach, with all women invited for mammograms at two-year intervals from age 45 to 69 (with plans underway to extend this to age 75). However, this uniform approach doesn't account for the diverse risk factors present in our population. For instance, women with a significant family history of breast cancer often require more frequent screenings, potentially annual mammograms complemented by MRI scans. Similarly, women with dense breast tissue may derive greater benefit from MRI screenings due to the limitations of mammography in detecting abnormalities in dense tissue. It's also important to note that Māori women face a higher risk of developing breast cancer, often presenting with higher-grade, faster-growing tumours.
Consequently, they may require more frequent mammograms, possibly in conjunction with MRI scans. On the other end of the spectrum, some women might benefit from less frequent screenings, perhaps every three years, while others with a life expectancy of less than five years may not require screening at all. This variability in risk and screening needs underscores the limitations of our current approach.
The prevailing one-size-fits-all strategy for breast cancer screening, while well-intentioned, has demonstrated significant limitations in addressing the diverse needs of our population. This realisation has spurred researchers to explore more nuanced, personalised breast cancer screening and prevention approaches.
Enter the WISDOM study (Women Informed to Screen Depending On Measures of risk), an ambitious and large-scale clinical trial that aims to compare the efficacy of standard annual mammograms with a more tailored, personalised screening approach. This innovative study is designed to evaluate whether a risk-based, personalised approach to breast cancer screening can improve patient outcomes while potentially reducing the negative impacts associated with over-screening. The personalised screening protocol in the WISDOM study takes into account a comprehensive array of risk factors, including but not limited to:
Lifestyle exposures, such as alcohol consumption, physical activity levels, and hormonal factors
Breast density, which can significantly impact the effectiveness of mammography
Genetic factors, involving the analysis of nine specific genes known to be associated with breast cancer risk
An SNP (Single Nucleotide Polymorphism) polygenic risk score assesses multiple genetic variations to provide a more comprehensive picture of an individual's genetic predisposition to breast cancer. This cannot be done yet in New Zealand.
One of the most intriguing aspects of the WISDOM study is its approach to tailoring screening recommendations based on each participant's unique risk profile. This personalised strategy means that women enrolled in the study may receive vastly different screening advice. For example, some participants deemed to be at lower risk might be advised to delay the onset of regular screening until age 50. In contrast, others identified as high-risk could be recommended to undergo annual mammograms in addition to MRI scans. This level of customisation represents a significant departure from the current standardised screening protocols and holds the potential to revolutionise breast cancer prevention and early detection strategies.
From my perspective as a healthcare professional, this personalised approach to breast cancer screening represents a potentially transformative advancement in the field. By tailoring screening intensity to individual risk profiles, we have the opportunity to improve patient outcomes across the board significantly. For women at higher risk, this approach could lead to earlier detection of breast cancers, potentially at more treatable stages. Conversely, for women at lower risk, it offers the possibility of reducing unnecessary procedures, thereby minimising the anxiety, discomfort, and potential over-treatment associated with false positives or the detection of low-risk lesions that may never progress to clinically significant disease. This balanced strategy promises to enhance the efficacy of our screening efforts and optimize resource allocation within our healthcare system.
While we eagerly await the results of this promising and potentially paradigm-shifting study, it's important to emphasise that women should continue adhering to current screening guidelines as recommended by their healthcare providers. Regardless of its outcomes, the WISDOM study represents an exciting and significant step forward in our journey towards more effective, efficient, and personalized breast cancer prevention strategies. As we move into this new era of precision medicine, studies like WISDOM are paving the way for a future where healthcare interventions are increasingly tailored to individual needs, potentially leading to better outcomes and improved quality of life for patients across the spectrum of breast cancer risk.