The WISDOM Study: Breaking the Deadlock In the Breast Cancer Screening Debate
An article commentary recently published in NPJ Breast Cancer, a Nature Research journal, discusses the WISDOM Study (Women Informed to Screen Depending on Measures of Risk (WISDOM), a groundbreaking clinical trial recruiting 100,000 women from throughout California that will compare annual breast cancer screening with personalized risk-based breast cancer screening. The study is led by Laura J. Esserman, MD, MBA (pictured), professor of surgery and director of the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Center. She and the other Wisdom Study and Athena (Athena Breast Health Network) investigators co-authored the article.
Abstract
There are few medical issues that have generated as much controversy as screening for breast cancer. In science, controversy often stimulates innovation; however, the intensely divisive debate over mammographic screening has had the opposite effect and has stifled progress. The same two questions—whether it is better to screen annually or bi-annually, and whether women are best served by beginning screening at 40 or some later age—have been debated for 20 years, based on data generated three to four decades ago. The controversy has continued largely because our current approach to screening assumes all women have the same risk for the same type of breast cancer. In fact, we now know that cancers vary tremendously in terms of timing of onset, rate of growth, and probability of metastasis.
In an era of personalized medicine, we have the opportunity to investigate tailored screening based on a woman’s specific risk for a specific tumor type, generating new data that can inform best practices rather than to continue the rancorous debate. It is time to move from debate to wisdom by asking new questions and generating new knowledge. The WISDOM Study (Women Informed to Screen Depending On Measures of risk) is a pragmatic, adaptive, randomized clinical trial comparing a comprehensive risk-based, or personalized approach to traditional annual breast cancer screening.
The multicenter trial will enroll 100,000 women, powered for a primary endpoint of non-inferiority with respect to the number of late stage cancers detected. The trial will determine whether screening based on personalized risk is as safe, less morbid, preferred by women, will facilitate prevention for those most likely to benefit, and adapt as we learn who is at risk for what kind of cancer. Funded by the Patient Centered Outcomes Research Institute, WISDOM is the product of a multi-year stakeholder engagement process that has brought together consumers, advocates, primary care physicians, specialists, policy makers, technology companies and payers to help break the deadlock in this debate and advance towards a new, dynamic approach to breast cancer screening.
Overall WISDOM study schema
Related Links
- The WISDOM Study: breaking the deadlock in the breast cancer screening debate (NPJ Breast) (PDF)
- Women Informed to Screen Depending on Measures of Risk (Wisdom Study) (WISDOM) Clinicaltrials.gov
- Massive study launched to test personalized approach to breast cancer screening (University of California News)
Related Videos
Introduction to Wisdom Study by Laura J. Esserman, M.D., M.B.A.
Video Discussing Athena Breast Health Network and Salesforce technology - pictured above (left) is Carlie K. Thompson, MD, former UCSF General Surgery Resident, explaining the screening program