A research initiative is using a cloud-based approach in an effort to improve breast cancer care, aiming to develop personalized screening approaches.
The Athena Breast Health Network, a long-established breast health collaborative, is conducting the initiative, aiming to use a digital engagement platform that seeks to achieve a couple aims—to provide a more secure and efficient way to store and share mammogram images, as well as better engage patients in their care by giving them access to their own images and data.
The WISDOM Study—Women Informed to Screen Depending On Measures of risk—is a five-year clinical trial comparing a comprehensive risk-based, personalized approach with traditional annual breast cancer screening. The trial is enrolling 100,000 women to determine whether screening based on personalized risk can deliver multiple benefits—in particular, if it’s safe, preferred by women, facilitates prevention and whether it’s adaptable in finding out who is at risk for what kind of cancer.
The Athena Breast Health Network is a collaboration between breast cancer experts, providers, researchers and patient advocates at five University of California medical centers and the Sanford Health System, a rural integrated delivery system based in Sioux Falls, S.D.
The overarching goal of the Athena study is to bring better evidence to breast cancer screening. Various groups set different screening recommendations for the age when women should start receiving mammograms and how frequently they should get them.
Recent studies suggest that annual screenings haven’t reduced breast cancer mortality, while there’s a significant likelihood of overdiagnosis, or a false positive result from standard mammography screening. Meanwhile, breast cancer treatment is moving toward a patient-specific approach that is tailored to individual patients—reducing false positives that traumatize those receiving them while taking into account individual characteristics, such as dense breasts, that complicate and potentially delay breast cancer diagnoses, thus delaying treatment and increasing the chances of mortality.
To support the study, Athena is using Mammosphere, running it on the Google Cloud Platform, as a patient engagement platform that stores breast health information and mammograms in a secure online environment. Mammosphere is powered by Life Image, a company that offers technology services that enables storage and exchange of clinical and imaging data from a variety of modalities.
Participants in the WISDOM study are not required to use Mammosphere, which enables women to request which of their records they want and where they want them to be sent. The WISDOM study is one of the recipients they can choose, and the convenience is helping to boost participation in the program—currently, nearly 23,000 women have signed up, with a projected goal of 100,000 participants.
Shortly after the WISDOM Study began, the Athena team realized that it needed a more secure and convenient platform to provide access to mammograms and other breast health information. That’s where the Mammosphere approach comes in.
“Mammosphere is a great adjunct for the WISDOM Study because we’re giving women something back: the ability to request and manage their breast health records,” says Allison Stover Fiscalini, director of the Athena network. “Women are joining the study to help generate new information about breast health, and they get a bonus of easy access to their records. We can assure them their data is highly secure because of the Google Cloud and Life Image partnership.”
Operating under Life Image, Mammosphere makes it easier for patients to acquire their images and direct them to whom they want, says Cristin Gardner, director of consumer markets and products for Life Image. For the Athena and Mammosphere approach to work Life Image depends heavily on a standards-based approach to take in images from a variety of vendors’ systems.
“For our purposes, the unique challenge of the WISDOM Study is to be standards-based and neutral enough, not tied to any one proprietary system—we have to be compatible with every proprietary system out there,” Gardner says. “Mammosphere is built on that—it acquires data, and once patients indicate they want to share it, we have put forth a lot of effort to make sure we are standards based and interoperable and can fit into a number of workflows.”
The research helps gather breast imaging and diagnostic information to enable researchers to fine-tune approaches for breast cancer diagnosis. For participants in the study, they get the ability to share data and images that are in their original format, in a DICOM format “that is not compromised,” Gardner adds. “What patients are getting from their providers and then sharing is of diagnostic quality, so there’s no loss of critical integrity.”
Current approaches to sharing information and images tend to be manual and ineffective. Faxing information between providers is not unusual, as is the practice of giving patients CDs with their images to bring to their next appointments.
“Patients in that situation are responsible for wrangling their records and will cart them around all over town,” Gardner adds. “The burden is on the patient. We know that women can get the best experience and outcome when they have their history in hand. It’s estimated that 30 percent of cancers can be caught earlier when patients have data and images. It’s incredibly empowering for patients to have this data, in the hands of radiologists who understand this.”