Can Personalized Screening with Genetic Testing Improve Mammogram Efficacy?

By Laura Freeman

Can Personalized Screening with Genetic Testing Improve Mammogram Efficacy?

Rachel Lancaster, MD

For decades, a routine annual mammogram has been the gold standard in breast cancer screening. It still is. But could a more precise, personalized screening plan that includes genetic testing and takes advantage of new technologies offer a better approach for individual women, especially those at higher risk?

That's the question UAB's O'Neal Comprehensive Cancer Center is hoping to answer with their involvement in the national WISDOM study - Women Informed to Screen Depending on Measures of Risk - that will include 100,000 women from across the country and 50,000 from all parts of Alabama.

"The study doesn't change the guidelines for an annual mammogram. It seeks to improve on them, looking at the best ways to make screening even more effective, particularly for women who may be at higher risk for breast cancer," breast surgeon and principal investigator Rachel Lancaster, MD said.

In spite of the remarkable advances that have been made in detecting and treating breast cancer, 42,000 American women still die of the disease every year. One out of eight women will be diagnosed with it at some time during her life. It is still having a terrible impact on women and their families, friends and communities.

An assistant professor in the division of breast and endocrine surgery, Lancaster said that the five-year study will compare screenings of women in two groups. One will continue with the usual schedule of annual mammograms. The other will add a more personalized approach that includes genetic testing and other techniques of precision medicine.

"We're hoping to recruit women from diverse geographic and ethnic backgrounds from across Alabama," Lancaster said. "Breast cancer screening is particularly important for women of African American ancestry. They tend to be at greater risk of dying from the disease.

"Women can participate from wherever they are in the state. There is no need to travel to UAB. They can continue to get their mammogram where they usually do and a copy will be sent to us. If the participant chooses the personalized screening group, we will send a kit for genetic testing that they can mail back."

Any woman, anywhere in the state who is between the ages of 40 and 74 and has not had breast cancer can qualify to participate. The website has more details, and women can sign up online in English or Spanish.

"Volunteers can choose whether they want to be in the mammogram-only group or the personalized screening group," Lancaster said. "If a participant chooses the personalized screening approach, the study takes into consideration genetics, family history, and personal history to determine the best way to screen with her particular risks in mind."

Factors that can affect quantifying of risk or screening recommendations include the presence of BRCA 1 and 2 genes or other genes linked to cancer, a history of breast cancer in a mother, sister, aunt or grandmother, or a high body mass index. High density that makes imaging difficult to interpret can also be a factor.

"We might also recommend MRI screening for participants who are at a higher risk of developing breast cancer," Lancaster said.

The WISDOM study began recruiting last year and is expected to continue recruiting over the next four years. Each participant will be followed for five years. Then, data from all over the country will be compiled and analyzed as the basis for recommending future screening guidelines.

By participating in the WISDOM study, Alabama women have an opportunity to make a contribution to improving the health of generations of women everywhere. They can also get a clearer picture of their own health with screening recommendations and risk reduction strategies.

To learn more, go to or call 855-729-2844.