This article was originally submitted as a Letter to the Editor of JAMA (Journal of the American Medical Association), in response to the article entitled “Risk-Based vs Annual Breast Cancer Screening: The WISDOM Randomized Clinical Trial”.
Written by Dorothy Levine, MD and Alvin Rosenfeld, MD
The WISDOM study demonstrates that using an innovative risk-based approach to select the appropriate breast cancer screening option is safe and acceptable to women.1 The authors identify the importance of developing improved models that best reflect an individual’s risk at any given time; certainly more liberal use of genetic screening is supported by the study’s finding that a significant number of women found to have pathogenic germline genetic variants did not report a family history of breast cancer.2
We have two recommendations for next steps. Although this study design excluded women with a prior history of breast cancer, the WISDOM study recommendation for increased screening protocols will greatly affect the more than four million breast cancer survivors currently alive in the US .3 These women have an increased risk of developing a contralateral second primary breast cancer.4 Hopefully this category of women will be included in the next phase of study.
When a woman is diagnosed with breast cancer, she is faced with a variety of options for treatment options and her urge to act immediately is great. She should be counseled that, in the long run, she will be more confident of her decision if she first takes the time to understand the long -term and short-term benefits and risks of each type of treatment available. As part of the initial exploration of her surgical, radiation, chemotherapy and hormonal treatment options the discussion should include the personalized annual estimated risk of a second malignancy over time along with the recommended screening protocol post-treatment to identify a recurrence. The frequency and intensity of follow-up recommended can influence a patient’s choice of initial treatment.
We are grateful to those researchers, physicians, patients, and publishers who worked to complete and share this study. The need to clarify, improve, and protect a woman’s ability to access the most effective diagnostic and treatment options both before and after a breast cancer diagnosis should be based on her individual profile of risk and personal preference.
Dorothy Levine, MD (1) and Alvin Rosenfeld, MD (2)
- NY Presbyterian Medical Center
- Corresponding author contact information: dorothylevinemd@gmail.com
