Breaking down barriers to breast cancer screening for high-risk individuals

woman in mask receiving mammogram at UChicago Medicine River East Solis Mammography location

The chance of developing breast cancer among American women is one in eight, or 13%. Screening offers the opportunity to catch breast cancers early, before they have progressed, allowing for better lifetime outcomes. Still, for some groups of women, their chances of getting breast cancer – and especially deadly, aggressive breast cancer – are higher than for others. The group that bears the most disproportionate burden of breast cancer is, by far, Black women.

The most recent statistics show that breast cancer is the most commonly diagnosed cancer among Black women, with 33,840 new cases estimated to have been diagnosed in 2019 alone.

What is more troubling is that the death rate from breast cancer is 39% higher for Black women compared with white women. Moreover, Black women are also more likely to develop breast cancers in their 40s — and to have more fast-growing forms of the disease that often prove difficult to treat.

The most susceptible women are ones with a personal or family history of cancer or who have an ancestry associated with BRCA1/2 gene mutations. These at-risk individuals should receive genetic counseling and genetic testing. Testing rates, however, are surprisingly low. They are far lower for Black women than for white women, and for uninsured patients than for insured patients.

To make matters worse, the COVID-19 pandemic is expected to have a devastating impact on cancer rates. Experts predict an unprecedented increase in the numbers of cancer cases and deaths because of delays in screening and care, intensifying the disparities already felt by under-served communities of color.

In order to tackle racial and socioeconomic disparities head-on, researchers at the UChicago Medicine Comprehensive Cancer Center have developed several cancer prevention studies. Each study looks for ways to make leading advances in breast cancer screening available to all women in the community, especially those who are most at risk of dying from breast cancer.

UChicago Medicine is one of the sites chosen to better understand the safest and most effective guidelines for breast cancer screening through a national study called WISDOM, which stands for “Women Informed to Screen Depending On Measures of risk.”

Participants can be healthy women between the ages of 40 and 74. Each participant gets to select one of two screening methods: a personalized, risk-based approach informed by genetic testing or the standard annual mammogram. This study of 100,000 women will contribute needed evidence to support guidelines for when and how often women should be screened according to individual risk factors.

CAPS

In the Chicago Alternate Prevention Study (CAPS), women at ultra-high risk for breast cancer — as a result of either genetics or dense breasts — are offered two screening scans per year using a new, ultra-fast MRI method developed by UChicago Medicine researchers paired with an annual mammogram. The study aims to show that the biannual 6-minute MRI scans are a safe alternative to prophylactic double mastectomy.

SCORE

With funding from the American Hospital Association Institute for Diversity and Health Equity and Blue Cross Blue Shield of Illinois, the SCreening OutReach and Engagement (SCORE) initiative offers free genetic testing for uninsured women who have never been screened. The women will also be provided free mammograms, help with registering for Medicaid, and transportation to get their mammograms. Community organizations, such as Equal Hope, Sisters Working It Out and Chicago Family Health, are helping to recruit community members.

One group, called Screen to Succeed, is led by Trisha Mondal, a sophomore at Adlai E. Stevenson High School in Lincolnshire, Illinois. As an aspiring oncologist, Mondal was devastated to learn about the lack of cancer screening among low-income and minority groups. In response, she built a website to raise awareness, funds and collaborate with local organizations to help battle healthcare disparities in cancer.

“There are many underutilized resources the community can take advantage of to get screened for breast cancer, but they are unaware or face barriers to getting help,” said Mondal. "By connecting them with resources, we can not only make it easier for them to get screened, but also educate them about cancer prevention.”

Technology’s Potential to Automate Screening

At-risk individuals are now at even higher risk because of COVID-19. The public health emergency has created safety challenges for patients to come in for screening or treatment.

UChicago Medicine researchers are partnering with the hospital’s genetics oncology group and using technology to streamline the process of risk assessment. When patients schedule mammograms through UChicago Medicine’s patient portal, MyChart, they automatically get a message asking them to answer questions about family history.

If a high-risk individual is identified, she can have virtual genetic counseling and receive a testing kit through the mail. This no-contact approach safely connects high-risk women with personalized cancer prevention strategies.

“Even during COVID-19 — a pandemic — we’re making breast cancer trials and screening accessible to women across socioeconomic and racial groups,” said Deepa Sheth, MD, assistant professor of radiology. “We want to transform the way we care for breast cancer patients.”

Altogether, the breast cancer screening initiatives and community-based efforts at UChicago Medicine are making prevention and risk reduction strategies accessible for at-risk women. The researchers hope these studies will improve breast care in a way that saves lives while closing the large gap in death rates between Black and white women, thereby making healthcare more equitable.

For more information about breast screening opportunities or ongoing research trials, email breasttrials@uchospitals.edu.


WISDOM Study and Breast Cancer Prevention: Q & A

The WISDOM study is a national research effort to determine if breast cancer screening can be made better by personalizing each woman's mammogram schedule. Learn about the study and important facts about breast cancer risk and prevention.

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