A personalized clinical decision tool for women at high-risk of breast cancer

2022

Challenge

In the U.S., each year there are more than 100,000 women at high risk of developing breast cancer due to their unique combinations of risk factors such as breast density, family history, age, and prior history of breast cancer. While that risk can be reduced using preventative measures such as medications and screening with mammography and magnetic resonance imaging (MRI) for early detection of breast cancer, each of these options has potential harms, including false positives and risks of additional cancers from the drugs. Ultimately, the choice of breast cancer prevention and screening may depend on how a woman will weigh the harms against benefits for these different options given her individual risk characteristics. Personalized clinical decision tools are useful in helping communicate and weigh the various benefits and harms of breast cancer prevention and screening; however, there are currently no such tools to support high-risk women.

Advance

A team of IRP researchers led by Jinani Jayasekera, Ph.D., M.S., developed a tool to provide the personalized lifetime benefits and harms of mammography screening and two risk-reducing medications, tamoxifen and aromatase inhibitors, in high-risk women based on their age, family history, and prior breast biopsy results. For example, according to the tool, a 50-year-old high-risk woman with a family history of breast cancer and a prior breast biopsy showing abnormal cells in the breast tissue could reduce her risk of invasive breast cancer by 36 percent, as well as lower her risk of dying from the disease by 57 percent, by utilizing risk-reducing tamoxifen, annual mammography screening, and MRI. However, risk-reducing tamoxifen could increase her risk of endometrial cancer by approximately 1 percent, and annual mammography screening with MRI could result in 2-3 false positive results over her lifetime.

Impact

This novel personalized tool provides data on the balance of benefits and harms of screening and risk-reducing medication for high-risk women. The information can help women and their healthcare providers discuss and find optimal strategies for reducing the risk of invasive breast cancer and breast cancer death. Dr. Jayasekera next plans to test the tool as a means of assisting decision-making during conversations with patients.

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