MORE THAN MAMMOGRAPHY
Modern breast cancer screening now includes genetic risk assessment
Breast cancer care in the U.S. has transformed over the past few years into an approach that focuses on preventive oncology, which boils down to knowing an individual’s risk before they get cancer.
The U.S. Preventive Services Task Force (USPSTF) and the National Comprehensive Cancer Network (NCCN) now recommend familial risk assessment for women with a personal or family history of breast, ovarian, tubal or peritoneal cancer, or who have an ancestry associated with BRCA1/ BRCA2 gene mutations. Women with positive results should receive genetic counseling and, if indicated after counseling, genetic testing.
Although genetic testing has become inexpensive and accessible, testing rates are surprisingly low. They are far lower for Black women than for white women, and for uninsured patients. These racial and socioeconomic disparities underscore the importance of programs that offer all patients who meet the USPSTF and NCCN criteria access to genetic counseling and testing.
UChicago Medicine researchers are addressing these disparities through several initiatives: WISDOM The Women Informed to Screen Depending On Measures of Risk (WISDOM) study invites healthy women ages 40-74 to select one of two screening methods: a personalized, risk-based approach informed by genetic testing or the standard annual mammogram. The national study is recruiting 100,000 women to better understand the safest and most effective guidelines for breast cancer screening.
CAPS
In the Chicago Alternate Prevention Study (CAPS), women at ultra-high risk for breast cancer — either as a result of genetics or dense breasts — are offered two screening scans per year using a new, ultra-fast MRI method developed by UChicago Medicine researchers paired with abbreviated MRI. The study aims to show that the six-minute MRI scans are a safe alternative to prophylactic bilateral mastectomy.
SCORE
SCreening OutReach and Engagement (SCORE) initiative offers free genetic testing for uninsured women who have never been screened. Community organizations Equal Hope, Sisters Working It Out and Chicago Family Health are helping to recruit community members.
Prevention Project
Researchers are using technology to streamline the process of risk assessment. When patients schedule mammograms through UChicago Medicine, MyChart automatically sends a message asking them to answer questions about family history. If a high-risk individual is identified, she can have virtual genetic counseling and receive a testing kit through the mail. This contactless approach safely connects high-risk women with personalized cancer prevention strategies.
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