Graham A. Colditz, DrPH, MD, MPH

Understanding how early life behaviors influence future breast cancer risk and refining risk assessment methods.

Impact

Improved breast cancer risk estimates are urgently needed to deliver personalized prevention. In his continued efforts to study the relationship between benign breast disease and risk of breast cancer, Dr. Colditz and his team are analyzing archived mammograms from routine screening of large groups of patients over time in hopes to develop refined models to predict when benign breast disease evolves to become breast cancer. These improved methods should identify high-risk women earlier and reassure women remaining at low-risk.

Progress Thus Far

Women undergo routine mammogram screenings, but images are not traditionally used in real-time to update future breast cancer risk assessments. Recent efforts by Dr. Colditz have focused on integrating changes observed in mammograms over time with existing questionnaire data. This new approach incorporates up to three mammogram images into risk models, significantly improving the accuracy of predicting breast cancer risk over the next five years. This allows for more personalized screening intervals.

Additionally, the team has evaluated risk factors for second breast events, such as another ductal carcinoma in situ (DCIS) or invasive breast cancer, using the Washington University in St. Louis Breast Health Tissue Registry in women with a history DCIS. They have developed a histology-based risk score that has shown superior prediction capabilities compared to current clinical prediction models.

What’s next

Building on their findings, the team will extend the use of the histology-based risk score to images of benign breast lesions that have potential to become pre-malignant, such as atypical hyperplasia. The team is refining a comprehensive statistical model that accounts for the progression from benign lesions to DCIS and invasive breast cancer. The model aims to clarify how various risk factors influence the transition to invasive breast cancer or protect against it throughout a woman’s life.