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Scott G Winterton, KSL

Intermountain Healthcare to study alternative breast cancer screening method

By Ben Lockhart, KSL  |  Posted Oct 9th, 2017 @ 9:42pm


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MURRAY — While her mother was close to dying of breast cancer at 50 years old, Linda Warner decided she would do everything in her power to avoid a similar fate.

"I made her a promise on her deathbed that I would get mammograms, take care of myself, do whatever it takes," Warner said.

Decades later, she said, "I'm grateful I did."

"I've been having mammograms for 30 years — no problems. Sure enough, last year there was a small tumor," the Sandy woman said.

Fortunately for Warner, her vigilance in getting regular screenings contributed to her cancer getting detected early — still in stage 1. A year later, she is cancer-free.

"I'm a believer in early detection, based on my own experience," she said.

It is experiences like Warner's that researchers at Intermountain Healthcare would like to see increase due to improved screening methods.

The organization announced Monday that it is launching a yearslong study into whether a blood test developed by researchers to look for DNA linked to a cancer tumor can improve early detection of breast cancer.

"We don’t know if this test will be effective, and that’s what this study will be evaluating," said Dr. Lincoln Nadauld, executive director of the Intermountain Healthcare Precision Genomics Program and co-lead investigator in the effort.

Nadauld said the study will last at least three years.

"We anticipate that in total we will enroll several thousand patients," he said.

The recruiting of study subjects will include allowing volunteers to sign up at the time of screening. Screened subjects' DNA will be compared with those from a group of patients already known to have a breast cancer diagnosis as a way to help determine the test's effectiveness.

"If we’re lucky enough to identify markers of cancer … we anticipate this is something that could be used (to) complement mammograms," Nadauld said. "This is a way patients could get screened even earlier with a (blood) test."

Intermountain Healthcare spokesman Jess Gomez said the study will be conducted by seeking out "little pieces of DNA that come from dying cells in the peripheral blood stream," specifically those of "circulating tumor cells."

Gomez said Nadauld would like "to use those markers to identify breast cancer, perhaps even before mammography can detect it."

The high volume of patients who already come to Intermountain Healthcare, plus the technological abilities the organization enjoys in studying genomics, make the hospital system uniquely suited to carrying out a robust study on the blood test, Gomez said.

Intermountain Healthcare conducts about 40,000 mammogram screenings per year, including 20,000 at Intermountain Medical Center in Murray, said the study's other co-lead investigator, Dr. Brett Parkinson.

Parkinson, who is also the medical director of the Intermountain Medical Center Breast Care Center, stressed that a blood test screening tool, even if it is found to be effective and reliable, would not make mammograms obsolete.

In the event a blood test eventually proves to be more effective, a mammogram would still come into play, he said. "We'll have to find (the location) of the cancer because the cancer has to be treated."

Such a test would be considered a diagnostic mammogram, rather than a screening mammogram.

Dr. Lincoln Nadauld, executive director of Intermountain Precision Genomics, left, Dr. Brett Parkinson, a radiologist with the Breast Care Center at Intermountain Medical Center, and Linda Warner, a breast cancer survivor, discuss the launch of a cutting-edge genomics breast cancer study for Utah women during a press conference in Murray on Monday, Oct. 9, 2017. The study seeks to determine whether specific blood tests that look for DNA from cancer tumors can be used to complement screening mammography to improve the way breast cancer is diagnosed. (Photo: Scott G Winterton, KSL)

Adding a new way to screen for the disease is important, Parkinson said, because "unfortunately mammography is not a perfect test." Mammogram tests have a false positive rate of 10 percent, Gomez said in a news release, "which may subject women to additional imaging and emotional duress."

"One of things we’ve tried to do over the last many years is look for more effective imaging (methods)," Parkinson said.

False negative results are also an issue in those tested via mammogram who have dense or very dense breast tissue, which is about 50 percent of women, Parkinson said. Among those with dense breast tissue, up to 30 percent of incidents of breast cancer tested for are missed by mammograms, he said.

"What we want to do is find those tumors before they’re a problem. Not all women are so lucky as Linda was," said Parkinson, who was Warner's doctor and diagnosed her cancer. "We need to find a new way to cut through the noise and allow us to see those cancers early."

Many patients view a blood draw as "a little less uncomfortable than a mammogram," he said. According to a description online from the renowned Mayo Clinic, "during a mammogram, your breasts are compressed between two firm surfaces to spread out the breast tissue."

"Then an X-ray captures black-and-white images of your breasts that are displayed on a computer screen and examined by a doctor, who looks for signs of cancer," Mayo Clinic's description states.

Nadauld and Parkinson both said the limitations of the mammogram test should not dissuade Utah women from being screened every year after turning 40, adding that the blood test is not proven and can not currently be characterized as a replacement screening.

Utah consistently ranks close to last in percentage of women who routinely get mammograms, and that needs to change, they said.

Dr. Lincoln Nadauld, executive director of Intermountain Precision Genomics, left, Dr. Brett Parkinson, a radiologist with the Breast Care Center at Intermountain Medical Center, and Linda Warner, a breast cancer survivor, discuss the launch of a cutting-edge genomics breast cancer study for Utah women during a press conference in Murray on Monday, Oct. 9, 2017. The study seeks to determine whether specific blood tests that look for DNA from cancer tumors can be used to complement screening mammography to improve the way breast cancer is diagnosed. (Photo: Scott G Winterton, Deseret News)

Nadauld said the mammogram testing method, even with its imperfections, is the "only screening that’s ever been proven to reduce mortality rate associated with breast cancer."

"The most important message we could possibly share is that patients should get their screening mammograms," he said.

About 65 percent of eligible women over 40 are screened for breast cancer using a mammogram, according to Intermountain. At an event last week naming October as Breast Cancer Awareness Month, Gov. Gary Herbert said the statewide goal is to increase that number to 76 percent by 2020.

"I think we can do better," the governor said at the time. "We must do better."

Joseph Miner, executive director of the Utah Department of Health, last week said 1 in 8 women will develop breast cancer in their lifetime, with three-quarters of cases not being considered hereditary.

The Centers for Disease Control and Prevention has said nearly 237,000 women in the United States were diagnosed with breast cancer in 2014, the most recent year for which that data is available.

The American Cancer Society has predicted that more than 40,600 women nationwide will die from breast cancer in 2017.

Warner said she is intrigued by the possibility of more precise testing for breast cancer, and she hopes the next generation in her family will benefit from it.

"I am so excited by this," she said. "Now I have daughters in their 30s … and I'm excited for them."

Parkinson said his goal is to ensure increasing numbers of women can look back with gratitude, like Warner has, for getting screened early.

"I would hope by the end of my career, we would have a test that is better and that no women would have to die from breast cancer," he said.

Researchers with the Stanford Genome Technology Center will be helping Intermountain Healthcare with the study, Parkinson said.

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