WISDOM Study and Breast Cancer Prevention: Expert Q&A

On average, every two minutes, a woman is diagnosed with breast cancer in the United States. Today on At the Forefront Live, we're talking about the WISDOM Study. It's a National Research effort to determine if breast cancer screening can be made better by personalizing each woman's mammogram schedule. Breast cancer specialty oncologist and researchers Dr. Funmi Olopade of UChicago Medicine and Dr. Laura Esserman of UC San Francisco will join us to discuss the study and its goal to enroll 100,000 participants. We will also have physician's assistant, Sarah Bazzetta on to discuss breast cancer risks and prevention and as always, we'll take your questions live. That's coming up right now on At the Forefront Live.

And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician and let's start off with having each of you introduce yourselves and tell us a little bit about what you do here use UChicago Medicine specifically Dr. Olopade, Dr. Esserman, you're obviously joining us from the West Coast but let's start with Dr. Olopade. 

Thank you for inviting me to this panel. I'm a breast medical oncologist but my main focus of research is to use genetics to improve care for all women and I serve as director of cancer risk clinic where we do risk assessments so that we can really optimize prevention for every man and woman at risk for cancer. 

And Dr. Esserman, if you can tell us a little bit about yourself and what you do at the UC, is it UC San Francisco? Is that correct? 

Correct, California San Francisco, yes. So I'm a professor of surgery in radiology. I actually direct our multidisciplinary breast program, our breast cancer program and I am focused on precision medicine approaches to both treatment, screening and prevention and really particularly interested in developing clinical trials and ways in which we can take some of the exciting new advances forward and all that we've learned about breast cancer biology and make sure that we can get the right treatment or screening and prevention strategy to every woman at the time that they need it to make sure that over the next 10 years, we really dramatically reduce the chance that anyone will die of this disease.

And that is a certainly a fantastic effort and I would be remiss if I did not say that I think both of you have been on the program before, about a year ago I think it was and we talked a little bit about the WISDOM Study back then and now we're into it a little bit more and the goal is to have 100,000 participants in the study, which seems like a pretty tremendous goal. But could you start us off by telling us about the WISDOM Study and Dr. Olopade if you can kick us off in just why this is so important?

Yeah, so October is when we ask every woman to come in and get a mammogram. The reason why Laura and I came together to talk about the WISDOM Study, which by the way means women informed to screen based on measures of risk, is because as a medical oncologist, sometimes we find women coming in with advanced breast cancer even when they have been having their mammograms every year and then Laura has a different problem where women come into her because they have been over diagnosed with cancer that would never have killed them, but because they got a mammogram alleged to fear and over diagnosis.

So we know that breast cancer is not one disease, that some women are going to get breast cancer that's very aggressive and some would get breast cancer that even if they didn't do anything about it, they may die of all that causes but we don't know who is going to get what. And I'm a Black woman. I don't know how to screen, when to screen, what to screen. I just hear that I'm at risk for triple negative breast cancer. So I'm asking myself OK, when I'm going to get that first mammogram, I need to do a little bit more questioning about what's my risk for cancer.

And since this is the work out that I have done at the University of Chicago for decades, I think it's about time for every woman, when you go in, when you start your screening mammogram at age 40 or any time, the study is open to women from age 40 to 75 and what we want you to do is ask can I participate in the WISDOM Study, may I choose a personalized arm or choose whatever I want to do? But let me be part of the solution so that we can know when a woman needs to screen, how they should be screened and so this study really is coming from California to the Midwest and I'm very proud that the University of Chicago has sponsored it and I'm participating in it and I'm asking all my friends to participate and because we live in a diverse community, I want Black, Brown, White, all women in Chicago to participate because together we can get the wisdom we need to know when to screen, how to screen and personalize screening for every woman.

So Dr. Esserman, I've got a two parter for you and this isn't based in part on what Dr. Olopade just told us and I've never thought of this before but so you have to, I'm certain, what doesn't surprise me is under reporting or under reacting but I hadn't ever thought of something that might overreact to a diagnosis. Can you talk a little bit about that? And then the second part of the question is if somebody wants to be part of this WISDOM Study, which it sounds like a great thing, how do they go about that?

OK, I'll answer both of those questions. Yes, actually overdiagnosis is really a problem because it can lead to overtreatment. As Dr. Olopade said, as Phil may said, every cancer is not the same and if you've got a cancer that's small and unaggressive, you don't need a lot of extra treatment and some of these cancers, especially some of these preinvasive cancers are never going to amount to anything. So we don't want to be doing mastectomies or giving people toxic therapy that they don't need. On the other hand, we want to make sure that we find that people with the more aggressive cancers and some people get these cancers that come up between screens and it's not their fault that they come in with a large cancer.

It's not because they've neglected it, it's because the cancer grew too fast. So is there a way that we can find those people through the study of genetics and looking at breast density, all those other factors that Dr. Olopade was talking about. That's what we're trying to answer in the WISDOM Study right and so the only way to do better is to know better as Maya Angelou says and so the only way all of us as women can make the future better is to join together and be part of the study. Women will spend 30 to 35 years of their life doing screening. Spend five years with us, help us find those right answers and this is just the beginning.

We not only want to find out when you start, when you stop, how often you screen but take the first part of that knowledge and then start changing and adapting and making it even more specific and more personalized. So over 30,000 women have now joined the study. We're a third of the way there. So you can be one of 100,000, everyone can. Tell all your friends and family. All you have to do is go to wisdomstudy.org, it's that simple. You can do everything online. The only one piece of information we need to know is your mammographic density from your mammogram if you've had one, we'll get that put in and everything else you can do from the comfort of your home.

And if you think about it, now more than ever at the time of COVID, wouldn't it be good to know? How important it is to go in? That's why if you know your risk, we believe that it's going to be better. But we're not just doing it, we're testing it so that our results can apply to everyone, so that guidelines can change, so that everyone can have a better option and that we're not only just screening, we're reaching out to people at high risk to see whether we can improve their chances and decrease their risk. So this is really a very important landmark study that again, all of us women need to stick together and be part of it and as Phoebe says we are both participating, so we put our money where our mouth is so you can do it too. If we all do it, we'll get better answers and we'll get them much sooner.

So wisdomstudy.org that's where people need to go if they want to participate in this study and we also encourage viewers as they're watching the program, if you have any questions for our experts today, please write them in the comments section. We'll try to get to as many as we can during the course of the show. So 100,000 would be the sample size that you're looking for and Dr. Olopade, we now know that you're about a third of the way there. When will we know the results or the outcome of the study? This obviously is a multi-year effort.

Yeah, so the reason why we really want to make this a national study and when my colleague called me, I call her my best science and research partner, Laura. The study at the University of California group, they had organized together across California to really do this study and so they formed the Athena Breast Network and then I was thinking why aren't we doing this in the Midwest? Why aren't we organizing in Chicago? And so as we have learned through this pandemic, we're all in it together and by being able to have testing available, by being able to share information that is really important to our health, I think we would learn how to do better with breast cancer.

So I totally agree with Laura when she said look, we're in a pandemic, we're all at home and we're wondering oh well, I don't want to go to the hospital, I don't want to go and get a mammogram or maybe I don't need it. Well cancer can be deadly if in fact you are at risk for an aggressive breast cancer. So I'm hoping that we will use this opportunity to just say yes, we can do both things, we can shelter in place, we can wear a mask, we can wash our hands and then those of us in the hospital, we're ready for you to come in and get your screening. So I know that there may be some women out there who do not have access to the internet, they cannot fill out the form in their own home.

Well when you come into your screening mammography, we would have a kiosk ready for you. We would have a way for you to be able to just put in the information so that we can then begin the process and that the process will get easier if we can just get all of us engaged in the process. Every woman is at risk for breast cancer and what we're really asking is let's all come together and join this study so we can get information that will inform all women, Black, White, Brown, mid-women in the Midwest, women on the coast and I'm looking for all my friends in Chicago to join, as well as all of our patients at the University of Chicago, other people will walk at the University of Chicago because together we can get the solution that we need.

And Dr. Esserman, you had a comment you wanted to jump in with?

I was just going to say it's just that easy. If you have a smartphone, go to wisdomstudy.org. That easy, you can sign up and importantly, we're trying to, by random, assign people to either the personalized or the annual arm right? But if you feel struggling, you want the personalized arm or you want to say oh, I want to get my annual mammograms, please, you can do that too. Just choose I want to choose, I want to choose my arm. Actually it's just so simple for everyone to join but we need everyone then to stay with us and make sure you keep in touch with us and let us know what's happening because that's how the study works and again all of us together, we can make the future better for sure.

Well it's so important. Dr. Olopade I appreciate you saying what you said a moment ago, get your screenings even with the pandemic, you still need to get your screenings and you still need to get medical care because first of all, come to the hospital. It's very safe but we don't want people to not do those things because it's just, it's not worth it. Get your screenings, you'll be safe, we make sure that people are very well taken care of. So doctor Dr. Esserman, question for you. Now when we talk about personalized mammograms, what exactly does that mean and how does somebody get their screening personalized?

Well so as Dr. Olopade said, we know that breast cancer isn't one disease and today, we don't treat everybody like they have the same cancer. So it may be for screening and prevention, that one size doesn't fit all. Instead of telling everybody get a mammogram at 40 and do it every year, maybe there are some people who really are at very low risk and they can start screening when they're 50. But there are other people whose risk is quite a bit higher and in fact, there's a combination of things that we can learn. It's not only what your family history is and what your, and what other risk factors you might have, but we can learn about your genetics and what does that mean?

Just with the spitting in a tube, we can understand what your DNA is made of. We can find out if you happen to have one of the very uncommon errors in one of the genes that puts you at very high risk for breast cancer. If you have some background genes that when combined together, really do either increase or decrease your risk. Well we may be able to say hey, you are really at risk and you're probably at risk for a hormone cause of breast cancer, we have something we can do to help you reduce that chance of getting a cancer and it's safe and work with you on that.

Maybe if you're a very high risk, you should come in, get a mammogram alternating with an MRI every year and so if you're in that very high risk group. So again, it's about when to start, how often to screen and with what type of screening you should use and would you benefit from prevention and if so, is that prevention working? That's how we're going to move the field forward. We believe that that's better but we're testing it. We want to find out if it's just as safe as the annual screening, if it leads to fewer false positives and scares like Dr. Olopade was talking about earlier.

Whether women prefer that and can follow that protocol and whether at the end of the day, we do better with prevention. That's what the study is all about and if we show the personalized screening is a better way forward, we can just continue to make it better and better. That's the way that we're going to prevent breast cancer.

Yeah, I just want to say that in October, we celebrate Breast Cancer Awareness Month. But we also remember that there's so many women out there now living with metastatic breast cancer who are looking for us to get new cures, new drugs and bring new drugs to help them beat or live longer with breast cancer. So I just want to take a moment to say that because of genetic testing and because of the research that we have done, we have more chances that women would live even longer with advanced breast cancer and that's why we're really seeing yes, we start with prevention before you ever get that first mammogram.

Help us look at when to begin screening or how to screen you. But even after you are diagnosed with breast cancer, we know that using targeted therapy, using genetics to inform how you get treated has changed the games for so many women and that's why at the University of Chicago when we talk about being at the forefront of medicine, it's because I research benefits, our population benefits women and I couldn't be prouder of what we have done during this COVID because we know yes, if you get COVID, you're more likely to die, if you are Black or Brown. Well guess what? If you have the right medication, if you get into the right clinical trial, you'll survive.

And so beyond COVID, we're talking about survivorship, giving yourself a chance to have early diagnosis and the only way that we get that is where you go in, get your mammogram and get good doctors to take care of you. So I hope that you will be part of that movement by signing up to become part of WISDOM. We hope we can follow you for the rest of your life because technology enables that to happen and we can share with you our research, we can share with you the latest findings, the latest kiosk so that those of you who are watching, who may be living with breast cancer now, think about your family members, think about daughters, think about sons, there's a lot we can do together. So that's why we're asking everybody to join this movement.

 All right.

And just a follow on that I was to say that one thing that we want to do in this study is do a special genetic profile of each tumor. So that's another benefit of being in the study. It will return that information to you right because this is our opportunity to figure out who is at risk for what kind of cancer and then really start to think differently about prevention.

All right, we need to take a quick break. When we come back, we'll have Sarah bizet to join us to answer questions about genetics and preventative oncology. We will be right back.

Thanks so much for having us.

All right, welcome back. We have a lot of good information about Janette or about the WISDOM Study in the first half the show. Now we're going to talk a little bit about genetics and prevention and Sarah Bazetta joins us to discuss that along with Dr. Olapade. Sarah, thanks for being with us and can you start us off just tell us a little bit about role here at UChicago Medicine?

Thank you for having me today. So I work with Dr. Olapade in the preventive oncology department. We work with whole families to make sure that they can do prevention and that we do early detection of cancers.

Great, well let's talk a little bit about preventative screening and how that works with genetic results because I know a lot of what we're seeing today and obviously with the WISDOM Study as well as looking at those genetic profiles of people that can help folks down the road. So Sarah, if you can start us off and talk about genetic screening with women and really how that changes the game actually?

Yes, so our department in preventive oncology really looks at whole family and family history and based on the family history, many patients benefit from knowing more about their genetic makeup because some genetic makeup have a higher risk of cancer and so those patients can benefit from, as we said, in the WISDOM Study, earlier screening, different types of screening and you can get involved multiple types of cancer prevention beyond even breast cancer.

So Sarah, can you talk to us a little bit about the preventative oncology clinic? I think that's what Dr. Olopade called it and the second part of that question would be how much of this can be done via telehealth if people are trying not to get out too much?

That's a great question. So almost all of it outside of the imaging can be done by telehealth. So our patients come to us through a call like we're doing right now and we talk about their family history, their personal history, their genetics and we talk about how to plan a personalized screening plan, whether that includes mammogram, ultrasound, et varieties and visits with us. So they come in and they see me. As part of our preventive oncology clinic, we have genetic counselors, we have oncologists, we have gynecologists and we have GI specialist because so much of cancer is a whole body of approach.

We also talk a lot about prevention outside of the hospital, diet and exercise. Being healthy is really important. Limiting alcohol and smoking and all of this is a whole body approach to prevention that we can get to patients before they have a diagnosis with cancer.

And Sarah, part of what you do also is really provide hope to folks because I know when you get a cancer diagnosis. It's a scary, scary event and I think for a lot of people initially there is that fear and then they wonder what happens next or how can I help myself down the road. So a lot of what your work does is, I would assume, is to help people realize that you can put together a game plan.

Yeah, that's such an important thing. Dr. Olopade's work for the last 30 years has really advanced what we can offer patient, both those that have cancer and those family members that want to prevent cancer. And so this game plan, whether it's by telehealth and then coming into the hospital to have your screenings can be proactive and can take an active role in their health.

So Dr. Olopade, we have another question from a viewer and that is can men participate in the WISDOM Study?

Oh, absolutely. The reason why how men can participate in WISDOM Study is they can get their wives and daughters to be participants. Unfortunately because men, the risk of breast cancer in men is very low, we cannot really learn how much we need to learn by having men participate in WISDOM. But the good thing about WISDOM is that you get your genes from both your father's side and your mother's side. Knowing that you're BRCA2 mutation carrier only increases your risk for prostate cancer is a big deal. Knowing that you're a BRCA2 carrier and you have a risk for all that cancers, can you help men also actually help their daughters.

So that's why we say we're in this together, men and women should know about the WISDOM Study but only women can participate and if we can use the genetic testing to reach men who may be carrying genes that increase the risk for their daughters or their sisters, that's really why we want everybody to be part of the movement. So yes, men can participate by urging their wives or their daughters or their mothers to be part of the solution.

Sounds great. Sarah, this is--

Dr. Olopade brings up a really good point that breast cancer risk comes from both mom's side of the family and dad's side of the family. So you want to see all of those patients at our clinic to talk about their families.

So Sarah, there's some practical just everyday things that can be done to help prevent breast cancer?

Yes, so the most important thing that you can do is maintain a healthy lifestyle. So exercising every day is good for both your physical health and your emotional health during this pandemic. So we really want everyone to stay active even in the upcoming winter month, get outside and make sure that you're staying active every day. And then eating a healthy diet is really important because we want everyone to maintain a healthy body weight so that we can reduce the risk of cancer.

So Dr. Olopade, we have another question from a viewer and this will have to be our last one. We're about out of time but I think this is an important one and the question is I was just diagnosed with breast cancer this year. Would this study be a good idea for my sisters to participate in?

Absolutely, absolutely. And the good news is we have more survivors and I hope you listen to that ad from the University of Chicago. It's not just that you a survivor, you are a thriver. So congratulations to you. But now the job that you have to do is get all your friends, get your sisters, get everybody in your family to feel empowered. There's a lot we can do. Even if you don't get to prevent cancer, you can give your sisters the gift of having their breast cancer diagnosed early. It's a game changer when your breast cancer is diagnosed early. So let's thrive beyond a diagnosis of breast cancer by sharing with our friends, with our family, everyone in your network, they can help us through that WISDOM Study.

So our personal challenge to everyone who's watching this is go to wisdomstudy.org. Sign up, encourage your wife, your girlfriend, your daughter to sign up if you're a guy watching this. It's very important. This is a great information and I know you need 100,000 people for that sample size. So we need to get a few more people signed up. We are out of time. You all were fantastic and shared just a lot of great information with our audience today. So thank you very much and thank you to our viewers for your great questions and please remember to check out our Facebook page for our schedule of programs that are coming up in the future.

Also, if you want more information about UChicago Medicine, take a look at our website at uchicagomedicine.org. If you need an appointment, you can give us a call at 888-824-0200 and remember, you can schedule your video visit by going to the website. Thanks again for being with us today and I hope you have a great week.