WISDOM Study

Turning Insight into Action: An OBGYN’s Journey Through the WISDOM Study

Steffanie Goodman — Fri, 30 May 2025 21:17:37 +0000

An Interview with Dr. Heidi Arbona, OBGYN & WISDOM Study Participant

Interviewer: Can you tell me a little about yourself?

Dr. Heidi: Sure! I’m 53 years old and an OBGYN. Over the years, as both I and my patients have aged, I’ve developed a deep interest in perimenopause and menopause care. Surprisingly, I didn’t learn much about this in med school or residency, so I did a deep dive into menopausal medicine. I even attended the Menopause Society conference in Chicago last year. That’s where I first learned about the WISDOM Study.

Interviewer: How did you get involved with WISDOM?

Dr. Heidi: After learning about the study at the conference, I was intrigued. I contacted my office manager and asked her to feature it on my clinic’s website. Then I enrolled myself. I’ve referred many patients to WISDOM since then and have it prominently displayed on our homepage at Northside Women’s Health in Westerville, Ohio.

Interviewer: What was your experience like as a participant?

Dr. Heidi: It was eye-opening. I had been getting annual mammograms and ultrasounds due to my dense breast tissue, and everything had always been normal. Through WISDOM, I found out I had a CHEK2 mutation. A genetic counselor from the study reached out to me and spent nearly 30 minutes on the phone explaining everything clearly and compassionately. She reviewed my family history, walked me through the implications of the mutation, and emphasized the importance of breast density and lifestyle factors. She recommended that I meet with a genetic counselor in person and also consult with a breast surgeon.

Interviewer: What happened next?

Dr. Heidi: I followed through and met with a hospital-based genetic counselor, who offered me additional RNA testing. She explained that while it was unlikely to yield new information for my specific case, it could benefit family members by making future testing for them more accessible and affordable. That was something I hadn’t known as a physician. After that, I met with a breast surgeon, who recommended switching from automated breast ultrasound (ABUS) to an MRI due to my extremely dense breast tissue and genetic mutation.

Initially, the cost of a traditional MRI was daunting—about $1,700. But I learned our hospital offered a self-pay abbreviated breast MRI for around $300. My breast surgeon and even my husband, who is a radiologist specializing in mammography, agreed that this imaging was excellent for screening purposes. That imaging revealed abnormalities that required further investigation.

Interviewer: That must have been difficult to hear.

Dr. Heidi: It was, but I was able to get a biopsy quickly that revealed DCIS. My surgeon offered a lumpectomy with radiation or mastectomy, or bilateral mastectomy given the mutation, my extremely dense breast tissue, and the chance that I could someday develop abnormalities in the other breast. I ultimately chose to have a bilateral mastectomy with reconstruction and I’m grateful I did. My pathology report showed additional concerning areas in both breasts, including Grade 3 DCIS and multiple areas of atypical hyperplasia in my “normal’ breast. Unfortunately, I needed a second surgery to address a positive margin in my affected breast. My final pathology demonstrated negative margins.

Interviewer: How are you doing now?

Dr. Heidi: I’m recovering well. I’m four weeks out from my second surgery, cleared for exercise, and feeling more like myself. I’m grateful for how quickly everything moved once I was in the system—from testing to imaging to surgery. I truly believe that being part of WISDOM helped me catch this early and avoid more aggressive treatments.

Interviewer: Has WISDOM impacted how you talk to your patients about risk?

Dr. Heidi: Definitely. I already focused on breast density and lifestyle factors, but now I speak more about personalized risk. I refer many patients to the study. It’s accessible and offers meaningful information that can change lives.

Interviewer: What would you say to someone who is hesitant to join the study?

Dr. Heidi: I’d say, know yourself. If information empowers you, this study is incredibly valuable. It can help identify risks early and offer a roadmap for prevention. But if you’re someone who would feel overwhelmed by knowing you carry a mutation, consider how you’d manage that information. The process itself is quick, easy, and can have a major impact.

Interviewer: Do you have any feedback for improving the study?

Dr. Heidi: Just continue to raise awareness, like what you are doing now. More people should know about it. I’m happy to help spread the word in my community and among my colleagues.

Interviewer: Thank you so much for sharing your story, Dr. Heidi. We’re so grateful for your insights and support.

Dr. Heidi: Thank you. I’m thankful to be part of it and to contribute in any way I can.

We are grateful to Dr. Arbona for sharing her experience with our community, and her ongoing support of the study.

Do you have a story to share? Email us at wisdomcommunity@ucsf.edu!

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How AI is Revolutionizing Breast Cancer Screening: Deep Learning and Breast Density Prediction

Steffanie Goodman — Tue, 27 May 2025 19:31:17 +0000

Understanding the Role of Breast Density in Cancer Detection

Breast density is a risk factor for breast cancer that’s getting a lot of attention right now. Dense breast tissue not only makes it harder to detect tumors on a mammogram — it’s also linked to a higher risk of developing cancer.

Now, a cutting-edge study from researchers at Taizhou Cancer Hospital in China is showing how artificial intelligence (AI) can improve how we assess breast density — making screenings more accurate, consistent, and equitable.

The Research at a Glance

Using data from over 57,000 mammogram images taken from nearly 10,000 women, researchers trained deep learning models to classify breast density based on the BI-RADS system which includes four categories:

• Almost entirely fatty

• Scattered fibroglandular tissue

• Heterogeneously dense

• Extremely dense

The top-performing deep learning model, InceptionV3, demonstrated impressive accuracy, particularly for the more challenging “dense” categories — where traditional assessments by radiologists often vary.

Key Findings

High Accuracy: InceptionV3 achieved strong predictive performance across all categories, especially for “heterogeneously dense” and “extremely dense” tissue.

Consistency vs. Human Readers: While radiologists performed well on low-density classifications, their accuracy dropped significantly on higher-density cases — where the AI model excelled.

Equity and Generalizability: The model performed consistently across different imaging devices and racial groups, supporting its potential for fair, scalable deployment.

Why It Matters

Breast density affects both cancer detection and cancer risk — and the ability to correctly determine density can differ from one provider to the next. This variability can lead to missed diagnoses or unnecessary tests.

Implementing AI for breast density classification could:

•Standardize assessments

•Reduce human error and inter-reader differences

•Support personalized screening and follow-up based on risk

The Future of AI in Breast Imaging

This research suggests a future where AI tools assist radiologists directly, improving accuracy and enabling more confident decision-making — particularly in complex or high-risk cases.

As deep learning continues to evolve, we’re likely to see its integration into routine care, helping save lives through earlier detection and smarter screening strategies.

Learn More

• Listen to the AI on Air podcast episode

• Read the full study on Nature Scientific Reports

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WISDOM Study Launches Groundbreaking Research on Environmental Exposures and Breast Cancer Risk

Steffanie Goodman — Wed, 30 Apr 2025 20:59:45 +0000

WISDOM is conducting a pioneering research study to explore how women’s exposure to environmental toxins in the home and the workplace influence breast cancer risk. Supported by a grant from the U.S. Department of Defense, our new project, led by Dr. Kim Badal, is designed to find out whether adding environmental exposure information into WISDOM’s breast cancer risk models makes them more accurate. WISDOM uses breast cancer risk models (similar to a calculator) to determine a woman’s risk for breast cancer, and decide how often a person should be screened and what type of screening should be done (mammogram, or both mammogram and MRI). Incorporating information on a person’s exposure to environmental toxins could transform breast cancer prevention and early detection strategies.

Understanding the Environmental Impact

Up until now, breast cancer risk models rely on a person’s health history, and do not take into account a person’s exposure to environmental toxins. New evidence suggests that factors such as exposure to pollutants where you live and work can significantly impact breast cancer risk. For instance, studies have linked living in historically underserved or impoverished neighborhoods or working night shifts to increased incidences of aggressive breast tumors.

Innovative Research Approach

To delve deeper into these links, this new research study will be offered to current WISDOM participants.

We will invite participants to complete detailed questionnaires about their work and residential histories.
Then our researchers will add information from some external sources to the participants questionnaire responses in order to estimate environmental exposure over time.
In addition, they will analyze stored saliva samples to examine DNA methylation patterns or how cells label or tag certain parts of the DNA, which can affect which genes are turned on or off, like using sticky notes to mark important sections of a document. This analysis may reveal how environmental factors influence how genes are expressed in breast cancer.

Again, this approach could enhance the accuracy of breast cancer risk models.

WISDOM Participant Involvement

Current WISDOM participants will be invited to contribute to this study by completing two surveys:

Occupational History Questionnaire: Collects information about jobs held from age 18 to present, including job titles, industries, and length of time. It also asks about the participant’s mother’s job history during pregnancy, since in utero exposures may affect breast cancer risk.
Residential History Questionnaire: Gathers information on all places where the participant lived for more than six months since age 18, as well as the mother’s residences during pregnancy.

These two surveys are designed to be thorough yet still manageable for participants to complete. In a test group, it took participants between 15 to 90 minutes to complete the occupational history survey, and between 15 to 30 minutes to complete the residential history survey.

How this study will improve healthcare in the future

By including information about environmental exposures into future risk models, the WISDOM Study hopes to:

Make breast cancer risk assessment more accurate.
Identify women who may benefit from tailored screening and prevention strategies due to their increased risk.
Contribute to public health policies to reduce environmental risk factors associated with breast cancer.

This research holds promise for more personalized and equitable healthcare, particularly for members of communities more likely to be exposed to environmental pollutants.

This work is led by Dr. Kimberly Badal, Assistant Professor, Department of Surgery, UCSF, in collaboration with Dr. Peggy Reynolds and Dr. Robert Harrison from UCSF’s EaRTH Center. It is assisted by Olivia Cooper, Research Assistant at UCSF, UCSF Research Advocates Diane Heditsian, Susie Brain, and Vivian Lee who represent the patient perspective to study leaders, and Lianna Hartmour from ZERO Breast Cancer who is developing communication about the study for the general public. This project is sponsored by the United States Department of Defense.

To learn more, check out:

this interview with Dr. Badal where she talks about her research on the environment and breast cancer risk
WISDOM’s environmental research page (scroll to the bottom for helpful resources to learn more about the environment and your health)

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The Path to Early Intervention: Build a Better Breast Cancer Predictor

Steffanie Goodman — Wed, 30 Apr 2025 00:00:58 +0000

UCSF researchers update Breast Cancer Surveillance Consortium risk assessment model with new risk factors for BMI and extended family history.

By Melinda Krigel, November, 2023

Breast cancer was the second most commonly diagnosed cancer in women, after skin cancer – accounting for 31% of all new female cancer diagnoses in 2022. Yet, determining who is most at risk of breast cancer is still a challenge for the medical community. Physicians use risk assessment models to determine when to start screening, the frequency of screening and need for prevention.

A leading model is the Breast Cancer Surveillance Consortium (BCSC) risk assessment calculator, which uses information about a woman’s age, race and ethnicity, first-degree family history of breast cancer, breast density and benign breast biopsy results to estimate a woman’s five- and 10-year absolute risk of developing invasive breast cancer. BCSC is a nationwide research network with community-based data collection from geographically and socio-demographically diverse settings that evaluates the benefits and harms of different screening approaches.

In a study publishing Nov. 17, 2023 in the Journal of Clinical Oncology, UC San Francisco researchers analyzed data from over 5 million screening and diagnostic mammograms to develop an updated BCSC model that adds new risk factors, including body mass index (BMI), second degree relatives with a family history of breast cancer and age at first live birth to improve model prediction.

“The new BCSC model (v3) updates an already well calibrated and validated breast cancer risk assessment tool to include additional important risk factors,” said Jeffrey Tice, MD, UCSF professor of Medicine, specializing in breast cancer risk assessment. “The inclusion of BMI was associated with the largest improvement in estimated risk for individual women.”

The researchers analyzed data from 1,455,493 women ages 35 to 79 without a history of breast cancer. During an average follow-up period of 7.3 years, 30,266 women were diagnosed with invasive breast cancer, breast cancer that has spread into surrounding breast tissue. The newly adopted BCSC model (v3) improved prediction of the five-year risk compared with the BCSC (v2) model. The new model showed the most improvement among Asians, Whites and Blacks. Among obese women with a BMI of 30 to 34.9 kg/m2, the true-positive rate in women with an estimated five-year risk of 3% or higher increased from 10% (v2) to 19.8% (v3), and the improvement was even more among obese women with a BMI ≥35 kg/m2 – from 7.6% to 19.8%.

First to use body mass index

In addition, current guidelines for the use of medicines to lower a woman’s risk for breast cancer are based on a women’s risk for invasive cancer in the next five years. The BCSC model (v3) is particularly useful to help guide decision-making in this context.

The BCSC risk model is recommended by the United States Preventive Services Task Force to identify women eligible for primary prevention with tamoxifen or an aromatase inhibitor. “Incorporating body mass index into the v3 model more accurately identifies overweight and obese women eligible for taking medication to reduce their risk of breast cancer,” said senior author Karla Kerlikowske, MD, UCSF professor in the Departments of Medicine and Epidemiology and Biostatistics and co-PI of the BCSC.

The BCSC model was the first to incorporate clinical mammographic breast density. Where breast tissue is dense, a mammogram of the tissue appears cloudy or opaque, making it more challenging to accurately detect cancer at its earliest stages and increasing breast cancer risk. The BCSC model provides risk information specific to the woman’s breast density assessment as well as other risk factors. Patients’ five- and 10-year risk for invasive cancer is estimated and the risk for an average woman of her age and race/ethnicity is provided for comparison and context.

“The updated BCSC model (v3) can help provide context for discussions between patients and their providers when a woman learns that she has dense breasts on her mammogram,” said Tice.

The research team will continue to use the BCSC database to help improve screening and surveillance. Tice hopes the findings will contribute to public health efforts to promote a more efficient risk-based screening approach to reduce breast cancer disparities.

Additional authors include: Charlotte C. Gard, PhD, MBA, Diana L. Miglioretti, PhD, Brian L. Sprague, PhD, Michael C. S. Bissell, PhD, and Louise M. Henderson, PhD

Funding: Breast Cancer Surveillance Consortium program project (P01CA154292). Data collection for this work was additionally supported, in part, by funding from the National Cancer Institute (U54CA163303) and the Agency for Health Research and Quality (R01 HS018366-01A1) and a Patient-Centered Outcomes Research Institute (PCORI) Award (PCS-1504-30370).

About the Breast Cancer Surveillance Consortium: BCSC is a collaborative network of breast imaging registries conducting research to assess and improve the delivery and quality of breast cancer screening and related patient outcomes in the United States. The nationwide research network uses community-based data collection from geographically and socio-demographically diverse settings and has a long history of evaluating the benefits and harms of different screening approaches.

About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is a top-ranked specialty hospital, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit www.ucsfhealth.org. Follow UCSF Health on Facebook or on Twitter.

Original publication: https://www.ucsf.edu/news/2023/11/426611/path-early-intervention-build-better-breast-cancer-predictor

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New Study Shows Racial and Ethnic Gaps in Follow-Up Care After Abnormal Mammograms

Steffanie Goodman — Fri, 18 Apr 2025 19:49:06 +0000

A recent study from the Breast Cancer Surveillance Consortium (BCSC), published in Radiology on February 18, looked at what happens after women receive abnormal results from a routine screening mammogram. The researchers wanted to see if women from different racial, ethnic, or socioeconomic backgrounds had equal access to follow-up testing—like more detailed imaging or biopsies.

The study, led by Dr. Marissa Lawson from the University of Washington, found that while most healthcare facilities had the necessary follow-up services available, not all women were equally likely to receive them—especially not right away.

What the study found:

Out of over 1 million women who had more than 3.5 million mammograms, most women had access to follow-up services regardless of their race, income, or where they lived.
However, Asian and Black women were less likely than White women to receive follow-up testing using a more advanced imaging technology (called digital breast tomosynthesis) within 90 days of an abnormal result.
Asian, Black, and Hispanic women were also less likely to get their follow-up testing on the same day as the abnormal mammogram, which can delay diagnosis and treatment.
Interestingly, women in rural areas were actually more likely to get same-day follow-up tests than women in urban areas.
Black women were less likely to get a biopsy—the test that checks if a lump is cancer—on the same day they had a concerning follow-up image.

Why this matters:

Catching breast cancer early saves lives, and that means getting fast, high-quality follow-up care after a screening mammogram shows something unusual. This study shows that not everyone is getting the same level of care, even when the resources are available. These differences could lead to delays in diagnosing breast cancer, especially for women of color.

The researchers say it’s time to take action. We need focused efforts to make sure all women, regardless of their race, ethnicity, or income, get the timely and appropriate care they need after an abnormal mammogram.

You can find the original abstract here.

Lawson MB, Zhu W, Miglioretti DL, Onega T, Henderson LM, Rauscher GH, Kerlikowske K, Sprague BL, Bowles EJA, O’Meara ES, Tosteson ANA, diFlorio-Alexander RM, Hubbard RA, Lee JM, Lee CI. Disparities in Standard-of-Care, Advanced, and Same-Day Diagnostic Services among Patients with Abnormal Screening Mammography. Radiology. 2025 Feb;314(2):e241673. doi: 10.1148/radiol.241673. PMID: 39964269. [link]

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The Link Between Breast Density & Cancer Risk

Steffanie Goodman — Thu, 17 Apr 2025 22:14:16 +0000

New Breast Cancer Surveillance Consortium study clarifies the association between breast density and cancer risk.

Repost of original article written by Jane Lange, PhD (https://www.bcsc-research.org/index.php/bcsc-blog/Breast-Density-and-Breast-Cancer-Risk-Linkage)

A new study in the American Journal of Epidemiology (February 2025), led by Jane Lange, PhD, clarifies the association between breast density and cancer risk. The findings show that dense breasts (BI-RADS categories 3 and 4) are linked to a 1.7-fold higher risk of breast cancer compared to non-dense breasts (BI-RADS categories 1 and 2).

The relationship between breast density and breast cancer risk is complicated by the fact that dense breast tissue reduces the effectiveness of screening mammograms, potentially delaying diagnosis. This issue, known as the ‘masking problem,’ has been recognized for decades. Less commonly acknowledged is that breast density may also influence screening rates, particularly in light of notification laws informing women of their increased risk—further impacting the timing of diagnosis.

This study presents the first rigorous modeling approach to assess how breast density influences the risk of disease onset—defined as the point when screening may first detect disease—independent of factors affecting the timing of diagnosis.

Key findings include:

In the BCSC, among women aged 40–54 undergoing their first digital mammogram between 2000 and 2018, mammography sensitivity was 73.7% for dense breasts and 87.7% for non-dense breasts.

Mammography attendance rates were 9% higher among women with dense breasts compared to those with non-dense breasts.

The relative risk of breast cancer diagnosis five years after the first screen was 1.8, compared to a relative risk of breast cancer onset of 1.7.

These findings support the current evidence base informing the Mammography Quality Standards Act (MQSA) that mandates that women be informed of the breast density status and the increased risk associated with dense breasts.

Lange JM, Gard CC, O’Meara ES, Miglioretti DL, Etzioni R. Breast density and risk of breast cancer: masking and detection bias. Am J Epidemiol. 2025 Feb 5;194(2):441-448. doi: 10.1093/aje/kwae245. PMID: 39098823; PMCID: PMC11815494. [link]

The full article can be found here

American Journal of Epidemiology

The accompanying editorial can be found here:

OHSU

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Shout Out to Women’s Health Experts

Steffanie Goodman — Fri, 13 Dec 2024 23:36:40 +0000

This Fall we had record breaking enrollment with an influx of women whose enthusiasm for making progress in women’s healthcare matches our own. We are truly honored to welcome you to our growing community and want to give a big shout out to the WISDOM champions who brought you to us!

A big round of applause for bringing breast cancer risk assessment and prevention to women across the US goes out to our partners at the Veterans Affairs; to our research and provider partners at Optum; to our provider partners at One Medical; to our new provider partners at Midi Health; and our to our new women’s health provider-champions who learned about WISDOM through the 2024 Menopause Society Meeting (or through other means) and have become ambassadors of the study.

Thousands of women have indicated learning about the study through these menopause and breast cancer experts (and the list continues to grow!), many of whom have online presence (social media accounts, blogs, podcasts) providing resources and information on menopause, symptom management, available treatments, and more:

Dr. Jen Gunter, Dr. Corinne Menn, Nurse Barb Dehn, Dr. Polly Watson, Dr. Lauren Streicher, Midi Health, Dr. Ghazaleh Afshar, Dr. Lilian Medhus, Dr. Eleonora Teplinsky, Dr. Leigh Lewis, Dr. Roxanne Pero, Dr. Sameena Rahman, Dr. Lisa Larkin, Dr. Erin Duralde, El Camino Women’s Medical Group, and the list goes on. We are so grateful for your support, and we’re honored to be serving your communities with personalized screening and precision prevention.

We recognize that thousands of our new participants learned about the study because they were seeking care or information on perimenopause or menopause. To this end, we will be publishing articles and hosting Community Forums throughout the coming year on menopause, hormone therapy, and their relationship to breast cancer/risk. If you have a particular topic of interest you want to learn about or you want to share educational resources with the WISDOM community, please email us at wisdomcommunity@ucsf.edu.

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Power in Numbers: 2024 Enrollment Roundup

Steffanie Goodman — Fri, 13 Dec 2024 22:30:43 +0000

This holiday season our team is celebrating the record-breaking enrollment of new study participants that joined us this Fall. Women from across the US, as young as 30, learned about the study from several sources that had a big trickle-down effect. It began with our scientists presenting at professional conferences, including Optum Grand Rounds (education for Optum physicians), and the annual Menopause Society meeting.

Attendees of those events enrolled in the study and shared WISDOM with their colleagues and patients near and far through presentations at conferences, social media posts, email campaigns, tv interviews, and more. Simultaneous to these events, our partners at the Veterans Affairs sent tens of thousands of emails to VA patients across the country who receive care from the VA, alerting them about WISDOM- thousands of whom have joined us.

We are thrilled to report that in the past year, over 21,000 women have signed up for WISDOM- nearly doubling the number of sign ups from the previous year. Over 5,000 of these women are between the ages of 30-39 and would likely not have learned about their risk for breast cancer through other means. To date, since the launch of WISDOM in 2016, over 91, 000 women have registered, helping us make significant strides in advancing breast cancer research.

We extend our heartfelt gratitude to everyone who has joined us on this journey—your participation is truly making a difference. The momentum continues to build, and the study is taking off as we head into an exciting new phase for WISDOM2.0 in 2025.

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Expanding Our Impact with Color’s Hereditary Cancer Test

Steffanie Goodman — Fri, 13 Dec 2024 00:53:13 +0000

At WISDOM, we operate on a continuous learning model. As we gain new insights from the data we collect – as well as breakthroughs in science- we incorporate those findings and update our study processes, operations, and scientific models. In October 2024, we entered a new phase of the study marked by the implementation of a larger genetic test to expand our impact even further.

The Next Gen Test

Our partners at Color have spent nearly a decade pushing the boundaries of delivering care from their early days in genetic testing to their expansion into a comprehensive Virtual Cancer Clinic. Now, they have broadened their testing offered to WISDOM participants to include additional cancer-related genes beyond those associated with breast cancer. The other cancer genes tested are associated with common hereditary cancers, including ovarian, uterine, colorectal, melanoma, pancreatic, stomach and prostate. The change came as a result of phasing out the prior 9-gene test, requiring an update of the panel to remain consistent with standardized testing procedures. While the adoption of the expanded test will not necessarily change participants’ breast cancer risk information, we are glad to be able to provide participants with more information about their overall cancer risk. The list can be found here: https://www.color.com/learn/color-genes#hereditarycancer

Color also provides additional genetic counseling services to support a growing number of participants. For those identified as being at increased risk for hereditary cancers not related to breast cancer, Color provides genetic counseling directly. For those identified as being at increased risk for breast cancer, Color ensures a seamless transition back to our team of geneticists and doctors whose expertise is in breast cancer risk and prevention.

How to Access It

New participants who enrolled in WISDOM’s “personalized group” beginning or after October 2024 will receive the 29-gene hereditary cancer test. In addition, participants who were in WISDOM1.0 and who choose to enroll in WISDOM2.0 (a new opportunity launching in 2025, for those who complete at least 3 years in the first version of the study) will also receive the 29-gene test. For participants who are not yet eligible to receive the 29-gene test through the study, the test can be purchased directly through Color. We recommend speaking with your provider before purchasing any genetic tests to determine which test may be best for you, and whether your insurance or employer may cover the cost. Important to note, the study continues to update and expand our genetic test offerings as we learn more (this is our 2nd expansion in just 1 year). Our procedures will continue to evolve over time, and we remain committed to offering our participants the best-in-class technologies as they become available for research purposes.

Committed to Advancing Cancer Care

The ongoing collaboration of WISDOM and Color is a testament to the power of partnership and innovation in cancer screening, prevention, and care. Color and the WISDOM Study believe that advancing cancer risk assessment requires more than just new technology — it requires breaking down barriers to access. That’s why our collaboration emphasizes making personalized cancer risk assessments available to more women, regardless of their location or background. By providing at-home genetic testing, we’re ensuring that every participant can take advantage of this groundbreaking research and make informed decisions about their health.

Through this partnership, we are working to reshape the future of breast cancer screening. Whether it’s refining risk-based screening strategies, identifying high-risk individuals earlier, or reducing unnecessary interventions, we are committed to improving outcomes for all women. This partnership embodies our vision of a future where cancer care is not just reactive, but proactive — where personalized medicine is the standard, and every woman can receive the care that’s right for her.

Resources to Learn More

For information about WISDOM & Color’s genetic tests and patient resources, visit these links

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Reduce Your Risk: Low Dose Meds

Steffanie Goodman — Wed, 27 Nov 2024 23:39:03 +0000

Research shows there are several ways to lower the chance of getting breast cancer. These evidence-based strategies are even effective at reducing risk for people with moderate or high risk from biologically driven factors, such as genetic mutations or dense breasts. One strategy is taking a medication called Tamoxifen. Tamoxifen is used to treat some breast cancers, prevent their recurrence, and help lower the risk of breast cancer in women who haven’t been diagnosed but are considered high risk. Tamoxifen is not recommended for everyone, just those at a high enough risk level.

How does Tamoxifen reduce risk?

Some breast cancer cells need estrogen (a female hormone) to grow. Tamoxifen works by preventing estrogen from attaching to breast cancer cells, and therefore not letting them grow. It is known as a Selective Estrogen Receptor Modulator (SERM). Tamoxifen can also help reduce risk by lowering breast density (density is a known risk factor for breast cancer). Tamoxifen is currently the only risk reducing medication approved for use in pre-menopausal women.

What is low dose tamoxifen?

Low dose tamoxifen, also known as baby tam, is tamoxifen taken in a smaller amount. The standard dosage of tamoxifen is 20 milligrams. Low dose tamoxifen is given at a dosage of 5 milligrams. Baby tam is shown to be effective at reducing risk with less side effects.

What are the side effects of Tamoxifen?

Some individuals who have taken tamoxifen at the standard dose have reported symptoms similar to those in menopause such as hot flashes, night sweats, cold sweats, skin rashes, vaginal discharge, weight loss, irregular periods, and muscle cramps. Though rare, it can cause serious adverse events such as stroke, or blood clots, and in postmenopausal women, endometrial cancer. The risk of adverse events is reduced when taking low dose tamoxifen in comparison to the full dose.

Women who are pregnant should not take tamoxifen. Also, women should not take tamoxifen for 3 months prior to getting pregnant.

Most people tolerate a low dose of tamoxifen very well and do not notice any significant changes after a month. Every individual should assess how they feel while taking the medication. If the medication causes significant side effects, it can be discontinued, and the risks and benefits reassessed with your provider.

Why take low dose tamoxifen over standard dose tamoxifen?

Low-dose tamoxifen shows a very similar ability to decrease breast cancer risk as the standard dose, while also causing fewer side effects and fewer adverse events (such as deep vein thrombosis, endometrial polyps, cataracts, or pulmonary embolisms).

Why take a medication when you can get a mammogram?

The goals of prevention (i.e. taking baby tam) and screening (i.e. routine mammograms) are different. Primary prevention attempts to reduce both your short-term and your lifetime risk of ever developing breast cancer, whereas screening attempts to find potentially harmful changes in your body (i.e. cancers) after they have already developed.

For most women under the age of 40, the risk of breast cancer is low, and thus screening would not provide a great added benefit. Women under the age of 40 also tend to have higher breast density. Unfortunately, mammograms are not as effective in detecting breast cancer in dense breasts because dense breast tissue and cancerous tumors both appear as white areas on the mammogram, making it difficult to distinguish between the two, and potentially causing a tumor to be missed. Because tamoxifen has been shown to reduce density of breast tissue over time, it can make mammogram screening more effective for high-risk women with dense breasts.

Screening tools such as mammogram have risks and benefits. Potential risks include increased false positives (when a mammogram shows an abnormality that appears suspicious for cancer, but after further testing, like a biopsy, it is determined that no cancer is present), which can lead to unnecessary procedures, anxiety and stress. Screening also does not prevent women from developing breast cancer.

Tamoxifen has an additional, long-term benefit: it continues to help reduce your risk even after you’ve stopped taking it. It is similar to taking statins for high cholesterol; even if you are unlikely to develop a heart attack or stroke now, taking the medication now can reduce the risk of negative cardiovascular outcomes in the future, which is preferable to having to find and treat these issues later. In the same way, some breast health experts recommend taking tamoxifen now, to lower your risk of developing breast cancer down the road.

Women who are younger when they start tamoxifen seem to have the greatest and most durable benefit. Taking risk reducing medication when you are younger is also important because the risk ratio is highest when you are younger—that is, you will likely experience more benefits and less chance of side effects.

What are the next steps if you’re interested in taking low dose tamoxifen?

If you believe you are a candidate for taking low dose tamoxifen and you are in the WISDOM Study, we highly recommend bringing your screening assignment letter, your genetic test results, and your breast health decisions tool summary, to your primary care provider or OBGYN to discuss a prescription of low dose tamoxifen. If you are not a WISDOM participant you should schedule an appointment with your primary care provider, OBGYN, or a high-risk genetic counselor to evaluate your breast cancer risk and decide whether tamoxifen is a good option for you. It is important to discuss other medications (prescription or over the counter) that you are taking with your physician before making the decision to start tamoxifen.

Where can I learn more?

You can learn more about tamoxifen at the following resources:

https://www.breastcancer.org/research-news/low-dose-tamoxifen-after-non-invasive-dx

https://pubmed.ncbi.nlm.nih.gov/36917758/

https://www.cancertherapyadvisor.com/home/cancer-topics/breast-cancer/breast-cancer-low-dose-tamoxifen-reduces-risk-long-term/

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