Breast Cancer

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Justine Shapiro
I am a Jewish woman from a family with a number of relatives who carry a genetic mutation known as BRCA. My maternal and paternal grandparents and great grandparents were born in Lithuania and Latvia, a part of the world where BRCA is prevalent in certain ethnic groups. People with BRCA are at significantly greater risk for certain cancers, most notably, breast and ovarian cancer.

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Breast cancer is the most common cancer in women and the fourth most common cause of death from cancer.

Much progress has been made in understanding the causes of breast cancer, but few options for prevention at the population level exist. Early detection by mammography has proven to lower mortality, especially for women over 50 years, but conventional mammography is unlikely to offer many new opportunities to advance the field.

Individualized screening for breast cancer along with an individual assessments of cancer risk is one promising area. The ATHENA Breast Health Network is a collaboration among the five University of California medical campuses through which some 150,000 women throughout California will be screened for breast cancer and tracked for decades. Also, the WISDOM trial, incorporating risk-based screening, is open to women in San Francisco. It is a cutting edge approach reducing incidence and mortality from breast cancer.

Other efforts focus on disadvantaged populations and breast cancer screening. Mammography facilities serving a high proportion of minority and immigrant women take substantially longer to follow up on abnormal mammograms than those serving other women. This is partly due to fewer resources to track and communicate with women and referring physicians, as well as handling follow-up imaging and biopsy appointments. Because these delays contribute to later-stage diagnosis and worse outcomes for breast cancer, an intervention to enhance processes of care (tracking, outreach/communication and care coordination, scheduling availability) for timely follow-up at these resource-strapped facilities, would lead to improved outcomes for vulnerable women.



SF CAN Actions



  • UCSF
  • San Francisco Department of Public Health
  • Zuckerberg San Francisco General Hospital and Trauma Center



Task Force Recommendations:



Goal: Improve rates of coverage and adherence to routine mammography among women at risk in the diverse communities of San Francisco

Work with the DPH and other health care entities in San Francisco to form a coordinated and integrated effort to improve use of mammography and reduce disparities for age-eligible women



Goal: Increase participation of women in San Francisco in the ABHN to enhance health education and promotion about state-of-the-science breast health and opportunities for research

Method: Promote participation in the ABHN and research opportunities designed to improve adherence to mammography screening guidelines



Goal: To advance modern risk based breast screening for all women in San Francisco with precision medicine approaches

Method: Through enhanced recruitment efforts engage diverse women in San Francisco in the WISDOM Trial

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