Top US Doctor Predicts Major Shift in Breast Cancer Risk Assessment

Deciding when to get routine mammograms has become increasingly confusing for women. Dr. Laura Esserman, breast cancer oncology specialist at the University of California, San Francisco, untangles doubts, shedding light on when and how often women should be getting checked for breast cancer. "Breast cancer is the most common cancer in women, and it is the second most common cause of cancer death after lung cancer," she says - also the primary reason behind organisations pushing women to start screening at 40; others suggest 45, while some guidelines still lean toward beginning at 50. These recommendations also vary between yearly and every-other-year mammograms. But what Dr. Esserman outlines, speaking to AP, is that not all women face the same

risk of breast cancer.

Breast Cancer is Not One Disease

According to Dr. Esserman, current screening guidelines are largely designed for women considered at 'average' risk. But determining who actually falls into that category isn't as simple as getting a mammogram. "Breast cancer is not one disease. It's a number of different diseases. Some are very fast and extremely aggressive. Some are extremely slow and indolent and such that your major risk is for overtreatment. So how in the world does it make sense to screen everybody the same when everyone doesn't have the same risk and they don't have the risk for the same type of breast cancer?," she asks.

Top US Doctor Predicts Major Shift in Breast Cancer Risk Assessment

The Abundance of Information is Confusing

Part of the confusion stems from changing recommendations issued by major medical organisations. "There's a lot of public health messaging from different groups," says Dr. Esserman, adding, "So the American College of Physicians just put out a guideline saying every other year starting at 50. That was what the US Preventive Task Force guidelines were. But they lowered that to 40 a couple of years ago. So yeah it's very confusing for women out there." The US Preventive Services Task Force updating its own guidance to recommend screening every other starting at age 40, instead of 50, not only proves her take, but also points towards the bourgeoning sense of anxiety associated with women and breast cancer screenings. The American College of Physicians recently advised that women at average risk between ages 50 and 74 should get mammograms every other year. Women between 40 and 49, meanwhile, are encouraged to discuss the pros and cons with their doctors before deciding whether to screen. In the same breath, The American Cancer Society has long recommended yearly mammograms for women aged 45 to 54, while allowing women to begin at 40 if they choose. The difference in opinions eventually boils down to every voice of authority trying to find a middle point between successful early cancer detection and avoiding unnecessary procedures, anxiety and overtreatment which can take a mental toll.

Mammograms are Not Perfect

Mammograms can occasionally miss cancers, while some suspicious findings turn out not to be cancerous at all. The equation here is simple - the higher a woman’s risk of developing breast cancer, the greater the benefit she is likely to gain from more frequent screenings. Dr. Esserman believes future screening guidelines will rely far more heavily on personalised risk assessments instead of broad age-based recommendations.She outlines: "There are standard risk factors that are part of these risk models that look at when you started your periods, whether or not you've had children, whether or not you've breastfed, whether you've had a biopsy, whether have any abnormal cells on that biopsy, and what your breast density is. Those are all factors that should be put together to help make screening."

Genetics Play a Big Role in Ascertaining Breast Cancer Risk

Genetics are becoming increasingly important in understanding breast cancer risk. Dr. Esserman explains, "Your genetics plays a role - whether there are some rare errors in some of the genes you inherit that can increase your risk substantially or maybe moderately. There's a bunch of genes that you inherit that by themselves don't mean much, but together they can confer either more risk or less risk." This phenomenon is called' polygenic risk'.In line with this, Dr. Esserman is currently working on the WISDOM trial, a large study exploring whether screening based on individual risk factors can work as effectively as standard yearly mammograms. The study used factors including genetics, breast density, lifestyle and medical history to classify women into different risk categories and assign personalised screening schedules.Early findings suggested that risk-based screening performed just as well as routine yearly mammograms. Researchers also found that many women identified as higher-risk through genetic testing did not have a known family history of breast cancer. Not just this, artificial intelligence tools are also being developed to help predict a woman’s future breast cancer risk using subtle clues detected in mammograms.Dr. Esserman believes the next few years could fundamentally reshape how breast cancer screening is approached. She affirms, "I think over the next year or two, we're going to see a big shift towards more comprehensive risk assessments and the ability to do a much better job of telling people when to start, when to stop, how often to screen, and what type of screening to use."