Esserman Helps Push Breast Cancer Prevention Beyond Routine Screenings

Vicki Hyman
Published: Monday, Feb 18, 2019
Laura J. Esserman, MD, MBA

Laura J. Esserman, MD, MBA

Which had to go, the nipple or the status quo? Laura J. Esserman, MD, MBA, was discussing an upcoming mastectomy with a patient when the woman asked a simple question: “Why do you have to take the nipple?”

“You have to learn most from what does not work,” Esserman said. “First, you understand what went wrong and why and then move on. Keep trying.”

No Stranger to Controversy

Esserman has never been a stranger to controversy, from her passionate call for the Equal Rights Amendment in her high school graduation speech (“I got a lot of flak for that,” she said, laughing) to a 2009 JAMA piece she coauthored with a prostate cancer specialist that argued that the benefit of breast and prostate screening came at the cost of overdiagnosis and overtreatment.

Try telling the 60,000 women diagnosed with DCIS in the United States each year, many of whom undergo lumpectomies, radiation, or even mastectomies, that they don’t actually have cancer. Initially, the hate mail—“scathing things,” according to Esserman—poured in from women who felt she had invalidated their experience, as well as from physicians against change. But now her inbox is full of messages from patients seeking less-intensive intervention and clinicians looking for better data and approaches.

Wisdom Study

Esserman showed that ultra low-risk cancers can be molecularly defined. Now she is taking it one step further with her WISDOM study, an adaptive, randomized clinical trial that looks at a woman’s individual risk factors—age, race, family history, breast density, genetics—and uses risk profiles to identify when women should receive annual or biennial mammograms, or no screening until age 50. Women found to be at the highest risk undergo an annual mammogram and magnetic resonance screening.
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