The dismal reality is that, despite all of the breakthroughs in novel treatments and more advanced means of imaging breast tissue, doctors are still not very adept at separating the women at highest risk from those at lesser risk when it comes to breast cancer. Every woman is screened for breast cancer based on the most basic risk factor: age.
This has resulted in a perplexing conundrum. While breast cancer death rates in the United States have decreased by 40% from 1989 to 2017, this progress may have come at a cost, resulting in a Goldilocks treatment scenario in which only certain women receive the exact screening and therapy they require.
A rising number of people are not having their malignancies discovered and treated early enough, or, on the other hand, are being overtreated for growths detected by advanced screening that will never turn into dangerous cancers. The general recommendation that women begin routine breast cancer screening at the age of 50 is proving to be a poor method of identifying those at the greatest risk of developing the disease.
Dr. Laura Esserman, director of the University of California, San Francisco Carol Franc Buck Breast Cancer Centers, states, “The only way to do better is to know better.” Esserman and her team have spent the last few years trying to figure out how to get doctors out of the same screening and treatment rut that has characterized breast cancer care for decades. To that purpose, Esserman devised the WISDOM research (Women Informed to Screen Depending On Measures of Risk), which aimed to fill in the most conspicuous gaps in our understanding of breast cancer management.
Rather of beginning with broad screening and treatment plans and fitting a wide population of women into those policies, regardless of their genetic history, lifestyle, or other risk factors, Esserman reverses the script and begins with the patient. The goal is to establish a tailored approach to breast cancer screening and treatment that takes into consideration the most recent research and breakthroughs in targeted anti-cancer medications, as well as the woman’s medical history and current health state.
With WISDOM, Esserman hopes to collect the data needed to formalize this precision medicine strategy by developing recommendations for a more customized approach to breast care that allows doctors to identify women at the highest risk of having aggressive disease and provide them with the appropriate treatment as quickly as possible. Esserman’s work on WISDOM has been documented by TIME throughout its creation in 2015 and launch in 2016, and she was named to the TIME 100 list of the world’s most important people in 2016.
Esserman intends to enroll 100,000 women in the study and assign them to one of two groups: annual screening or a more tailored approach over the course of five years. So far, 35,000 women have signed up, including African-American women and military veterans, who are underrepresented in breast cancer research. (The co-chairs and owners of TIME, Marc and Lynne Benioff, have been financial benefactors of Dr. Esserman’s breast cancer research.) Salesforce, where Marc Benioff is chairman and CEO, provides technological support for the WISDOM study.)
We’ll meet several women who are participating in WISDOM in a series of short videos for Breast Cancer Awareness Month this October, and explore what they’ve learned about their own risk for breast cancer, and how that knowledge has changed the way they think about the disease, from a woman who thought she was at high risk because of a family history of breast cancer.