In this study, participants in the risk-based screening were given screening schedules that depended on other detect risk factors (including genetic testing for variants associated with increased risk of breast cancer) ranging from every 6 months alternating MRI and mammograms for the highest risk group to less than the usual recommendation for average and lower risk groups. For the highest risk group in risk-based screening, there were many cancers detected, but none that got to stage IIB or higher before being detected.
I’ve been a member of the WISDOM study for several years. When I first enrolled I sent a sample and was found negative for breast cancer. Based on that and family history (maternal grandmother) they recommended screening mammograms every two years.
They recently segued into something called Color and offered me the opportunity for genetic cancer DNA testing. Why not, I thought. Results came in and nothing was identified in 29 genes associated with several medically actionable, hereditary conditions including some hereditary cancers.
The every two year recommendation continues.
It’s been a worthwhile experience.
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This month, for the first time ever, my OB/GYN ordered an MRI for me, which seemed odd as I tested negative for the BRCA gene. So why the MRI after already having a mammogram this year? I asked my PCP as I had an appt with him after the MRI recommendation, and he said that that’s the new standard for people with an increased risk. While the BRCA tests said that I was negative, they also said that I have a better than average chance of developing breast cancer based on family history, something like 28+% chance, so the recommendation is to alternate mammograms with MRIs.
I was in wisdom study and did genetic test and they said I was at low risk for breast cancer so recommended mammograms only every 2 years. I did that once but my docs objected and urged me to go back to every year mammograms, so I’m back to annual with apologies to the study.
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My sister was diagnosed with breast cancer last year. She was not in the Wisdom study. She waited 14-15 months between mammograms, just because of well…busy life. After diagnosis, she had a full genetic workup and had zero breast cancer markers (I couldn’t believe how many markers there are, over 100 IIRC.)
Had she waited another 9-10 months for a mammogram, that would have given the cancer more time to grow, and perhaps changed the treatment plan and/or outcomes. I know she’s just an n of 1, but that’s how (IMO) people have to think about their healthcare…at the individual level and do what is right for them.
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The mammography center where I go strongly urges women to go every year, regardless of risk factors. I actually talked to them about it this year if it was safe to go to every other year and they were adamant that some breast cancers grow so rapidly that two years is too long.
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I wasn’t in a high risk category for breast cancer. No diagnosed family members, good diet, no smoking, menstrual cycle after age 12, childbirth before 30 etc etc etc. I got mammograms every year from 40 on. Diagnosed at 44 - from an all clear mammogram to one showing three tumors. If I had waited 2 years between mammograms I would probably not be here in all honesty. My genetic testing was all negative.
I do the mamo and MRI switch every 6 months. I find it extremely stressful, yet necessary. False positives can be common and cause mental anguish for sure.
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My SIL went for her annual mammogram & found out she had stage I breast cancer - due to the type, her treatment has been brutal. Had she waited another year, it would certainly have been a sadder story. OTOH, my mom noticed a change to her breast shortly after her annual mammogram & went to her doctor immediately - turns out she had a cancerous tumor behind her nipple. I hope that women and their doctors are allowed to continue to make their own decisions.
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Self exam or exam by a medical provider is also quite effective. My breast cancer was found by a new PCP. It was in a location that was harder for me to palpate.
Gene tests are worthwhile but there are no doubt genes that have not yet been identified. Both my grandmothers and various aunts and cousins have had breast cancer, but not my mother or sister. I had many genes tested and all were negative. But I want my own daughters to be considered high risk even if my cancer was not proven to be genetic.
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This is true. Despite being around for some time, the field is still new.
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I had genetic testing done after I was diagnosed with stage 0 and my sister had been diagnosed in her late 20s (also stage 0). Nothing was found. My mother started getting mammograms again. At 85, she was diagnosed with stage 2, underwent surgery and 5 years of Anestrozole, which I tolerated well, and seems to have beat it.
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Yea, that was basically what my docs said. They were fine in the abstract with me being in the study but when it was recommending something that they didn’t like, they were pretty uniform in saying nope, just do annual mammograms. I had a friend who had stage 4 breast cancer over a decade ago. It was touch and go as to whether she’d live. We are going on a one month trip to Scandanavia in May this year. She’s a 10 year survivor!
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It looks like environmental influences were looked at beginning in October, 2023 but not prior…unless I am misunderstanding.
I’m one of 4 in my immediate family who has had BC. My mom and 2 sisters all had to get chemo, sisters also had radiation. I had radiation in 2007 and then a bi-lateral mastectomy in 2022.
I was getting mammograms beginning around 35, Stage 0 BC when I was 46 and again at 61. Not wanting to go through it again, I opted for surgery. At that point, my risk tolerance was way at the bottom of the scale.
No genetic markers for any of us (I was tested twice). We may have something that could eventually show or it’s just luck of the draw.
I’m firmly in the camp of any risk factors, go with more screening. My grandpa had colon cancer, which could increase risk for us, so that gives us the added joy of colonoscopies every 5 years. Dense breasts and mom brought earlier mammos for me. After my initial diagnosis, I had annual MRIs as well.
My daughters have been referred to the high-risk clinic. With any luck, it will skip them entirely.
No risk factors: get a good baseline mammogram, have it read by a radiologist who looks at a gazillion of them, and then go with their recommendation.
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As people might know, my daughter had breast cancer at 32. She has a genetic mutation that was passed through her father.
My husband has a higher risk of certain types of cancer. He had an endoscopy last year and is going to have an MRI next week. Getting insurance to pay for these procedures has been an issue. Last year’s endoscopy was expensive, we ended up paying quite a bit because we could not get insurance to pay for part. We are hoping Medicare is going to be better as far as allowing these.
There are a bunch of different genetic mutations, it’s not just BCRA as some might know.
My husband’s family has a lot of cancer in his history, where in the family tree my daughter’s came from is a mystery. Only my husband, and my son have tested, my son does not have the mutation. My husband’s sibling and parents have declined to be tested.
My mil’s siblings had breast cancer, my mil has not. She had sons. My fil’s mother had pancreatic cancer when she was in her 70’s.
It’s a mystery, but since my son doesn’t have the marker, my daughter has tested embryos, the disease will not move to later generations in our branch of the family tree. Now if my daughter can have a baby or can afford surrogacy, that would be perfect.
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A letter from a colleague of mine regarding the study:
When I first read about the “WISDOM” trial I suggested that the acronym could be:
W hen I ll-informed S urgeons D ebate O ver M ammography
Or
W hen I gnorance S ows D oubts O n M ammography
Unfortunately, this trial originated from the failure to understand that the Canadian National Breast Screening Studies (CNBSS) were hopelessly flawed (Esserman LJ; WISDOM Study and Athena Investigators. The WISDOM Study: breaking the deadlock in the breast cancer screening debate. NPJ Breast Cancer. 2017 Sep 13;3:34. doi: 10.1038/s41523-017-0035-5. eCollection 2017. Review) and that the claimed lack of benefit from screening was not based on science, but due to poor study design and compromised execution.
The WISDOM designers ignored the clear benefit proven by the other randomized controlled trials of screening. With the support of those wishing to limit access to screening (likely with a goal to save money) the WISDOM trial was, itself, created based on faulty arguments and poor study design (see attached - Kopans DB. The wisdom trial is based on faulty reasoning and has major design and execution problems. Breast Cancer Res Treat. 2021 Feb;185(3):549-556. doi: 10.1007/s10549-020-06020-7. Epub 2020 Nov 25. PMID: 33237397.)
It is a worthy goal to not have to bother and worry women who are not destined to develop breast cancer, and to only screen those who will develop these cancers. Unfortunately, the weight of decades of searching suggests that most breast cancers are sporadic and not predictable. In fact, the vast majority of women diagnosed with breast cancer (75%) each year have none of the known factors that elevate their risk. As far as we know, all women are at risk and should be encouraged to participate in annual screening (certainly starting by the age of 40). Ideally, women who are at major elevated risk should undergo more intensive screening, every 6 months, alternating mammography with MRI screening.
The preliminary results of the (“lack-of”) WISDOM confirm the concerns raised before the trial began. It will be unfortunate, given the erroneous arguments for undertaking the trial and its poor study design, that its results will, somehow, be twisted into another misguided effort to limit access to screening.
Dan
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This is important for people to understand (and it goes beyond screening for mammograms.)
Just living in our polluted environments presents and elevates cancer risk: air/water contaminants, pesticides, exhaust fumes, radiation, a barrage of microplastics invading one’s organs/tissues, etc. This is why I’ll continue to get annual mammograms. I sure hope insurance companies/Medicare/Medicaid don’t change their reimbursement policies based on the Wisdom study.
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