Researchers harness data from Million Veteran Program to improve breast cancer screening

One of the fiercest debates in health care in recent years has been about breast cancer. What is the best way to catch the disease early on? Should all women in a certain age bracket get mammograms? How often? And what exactly should the age cut-offs be?

Doctors disagree among themselves on these questions and different groups offer varying guidelines.

For example, the U.S. Preventive Services Task Force recommends a screening mammography every two years for women ages 50 to 74. For other age groups, the decision gets more complicated, based on many individual factors.

The American Cancer Society, on the other hand, says all women should begin having yearly mammograms by age 45.

VA researchers hope to bring more clarity to the issue by using data from the Million Veteran Program (MVP). Now with over 600,000 Veterans enrolled, MVP has become one of the world’s largest databases of health and genetic information.

Several studies are now underway using MVP data, and one of them focuses on predicting breast cancer risk.

Here’s the basic idea of the study: Follow tens of thousands of women who are enrolled in MVP, and who currently don’t have breast cancer. Study their genetic profiles—and all the other clinical, demographic and exposure information available in the database—and track which of the women develop breast cancer over time. The process should shed light on which risk factors matter most, and result in a prediction model that is more robust and precise than any in current use.

Using the new model, providers could recommend that women at higher risk start screening at an earlier age—40, say—and perhaps get a scan every year, versus every two years. Women with a very elevated risk might benefit from extra screening measures, such as a breast MRI.

Here’s what the researchers on the study say about what they hope to accomplish: “Our work will significantly enhance our abilities for early detection, and optimize and individualize breast cancer screening for all women Veterans and women in general.”

The team is led by Dr. Shiuh-Wen Luoh. A specialist in breast cancer, he is a staff physician at the VA Portland Health Care System, and an assistant professor at Oregon Health and Science University. Luoh says his overall career goal is to “bring laboratory research to patient care for the benefit of breast cancer patients.”

As of now, nearly 50,000 women are enrolled in MVP, and that number is growing. Women make up nearly seven percent of VA’s population. MVP has set the ambitious goal of having women represent 11 percent of the overall MVP cohort by 2020.

Importantly, some 20 percent of women now enrolled in MVP are African American. Current prediction models for breast cancer risk are based mainly on studies of older, predominantly Caucasian women. It’s not known whether certain genetic variants affect risk in the same way for white and black women. The new study will help answer that question, among others.

Also, past research on breast cancer risk has largely not accounted for the special health risks that women Veterans face. Intense physical training, for example, or deployment to areas with various environmental hazards could increase stress and add to cancer risk.

Kayla Williams, director of VA’s Center for Women Veterans, and herself a Veteran and military spouse, has expressed strong support for the study, and for MVP on the whole:

“As a proud participant in the Million Veteran Program, I’m thrilled to learn that upcoming research will help better predict breast cancer risk. Many women Veterans that I know are concerned that environmental exposures may have impacted their cancer risk, so it’s wonderful to know this pivotal work will help improve screening guidelines for our population. I encourage other women Veterans to sign up for MVP, too – it was fast and easy when I did it!”

To learn more about MVP, visit their website at https://www.research.va.gov/mvp/. And if you are a VA patient who has not yet enrolled in this landmark research effort, aimed at improving Veterans’ health now and in the future, please consider doing so.