October is Breast Cancer Awareness Month. I remember one weekend when our server served us a special rose-tinted cocktail for a local cancer ward. I didn’t need that (delicious) drink to remind me that breast cancer remains the most common cancer among women. But it got me thinking about how, despite decades of Pink October, our approach to breast cancer screening has changed little.
Although recommendations regarding screening frequency have changed in recent years, guidelines are still written for women at average risk. Oncologists now have more information about who is at risk for more aggressive cancers or cancers that develop at a younger age. So why aren’t women tested based on their individual risk?
“In an ambitious world, we want guidelines to be truly personalized or precision-based and adaptable over time,” the American Cancer Society’s top science author says. Director William Dahut said.
Such guidelines would consider factors such as genetics, breast density, and lifestyle choices when guiding how early and how often each person should be tested. A more tailored approach could not only save lives but also prevent low-risk women from undergoing unnecessary surgery due to incidental findings.
Modernizing mammography recommendations to better account for someone’s cancer risk may not sound like a radical proposal. After all, people are willing to accept their doctor’s instructions not to return for five, seven, or even 10 years based on the findings from their latest colonoscopy. But the paradigm shift in breast cancer screening has proven to be frustratingly controversial, and no one knows that reality better than Laura Esserman, director of the Carol Fran Buck Center for Breast Care at the University of California, San Francisco. not present.
Since 2016, Esserman has been working with Wisdom (based on measures of risk) to test the theory that a personalized approach can further reduce mortality rates and avoid unnecessary biopsies and treatments in women. has led a large-scale trial called “Informed Women Screening”.
It’s an effort that evokes emotions ranging from suspicion to full-blown vitriol. Some people balk at interfering with an approach that has undoubtedly saved hundreds of thousands of lives. Deaths from breast cancer have declined by 43% since 1989, and this improvement is largely due to a combination of better drugs and better screening.
But over the past decade, that decline has begun to level off. While efforts to improve screening adherence and invent better treatments may help, the field could also benefit from recognizing current imperfections in screening.
Esserman’s trial will determine whether people at highest risk can be identified and brought to the hospital sooner and more often, and whether, conversely, lower-risk people can be seen less frequently. is being tested. Although she still has more than a year to go before she has complete data, she has already found that her family history is not always a reliable predictor of genetic risk for breast cancer. . This fact suggests that inexpensive genetic testing should be widely available.
The best plan for people without known risk factors is to start getting mammograms at age 40 and ensure annual screening by age 45. Some people should start earlier, such as those who have mutations such as BRCA1 or her BRCA2, or those who have a family history of cancer at a young age. or dense breasts.