Introducing the Pitch Day Finalists: Implementing Risk-Based Cancer Screening Using an Adaptive Learning Engine

Oct 10, 2013, 8:00 AM, Posted by

Laura Esserman, director of the Carol Franc Buck Breast Care Center

Laura Esserman, MD, MBA, and a team of collaborators want to transform the way we screen people for cancer. The team is one of eight finalists we invited to pitch us their ideas live and in person at the first-ever Pioneer Pitch Day. Dr. Esserman's team was one of three presenters invited to submit a full proposal for potential funding.  

Dr. Esserman is the director of the Carol Franc Buck Breast Care Center and a professor of surgery and radiology at University of California, San Francisco. You can follow her on Twitter at @DrLauraEsserman. Her collaborators are NCQA's Margaret (Peggy) O'Kane and Clarence So of Salesforce.

Pioneer: Congratulations on being a Pitch Day finalist! What made you decide to submit your idea?

Laura Esserman:
Screening is a health issue that affects everyone. In aggregate the resources used to screen for diseases are enormous. The vast number of false positive recalls drives over treatment at the same time as a large number of lethal cancers are missed. There is an enormous opportunity to innovate by integrating automated risk assessment and adaptive learning. We can take an issue that is incredibly contentious and drive innovation and learning, and integrate new methods for risk assessment and prevention, and provide much more value at much lower cost.

Pioneer: Tell us about the origins of your idea.

Esserman: I have been working on ways to integrate management science and technology into medical practice to drive value and innovation into health care for the last 20 years. My clinical specialty is breast cancer and I have worked on integrating advances in treatment into the screening and prevention arena. In particular, I have taken a leadership role in identifying and addressing the need to tackle over-diagnosis and over-treatment. Focusing screening on those at highest risk will enable us to maximize benefit and minimize harm.

Pioneer: What do you believe is the most innovative aspect of your idea?

Esserman: The most innovative aspect of my idea is taking a systems-based approach to screening that includes the integration of comprehensive risk assessment at the time of screening and the molecular profiling of tumors that arise. By doing this, we learn who is at risk for what type of cancer and can learn as we go, adapting screening frequency based on interval cancer rates, tumor type and stage. That way, we can innovate perpetually and accelerate knowledge turns, to the benefit of the entire population. We have now learned that breast cancer is not one disease, but many, each single one with vastly different characteristics and lethal potential. We therefore need to tailor screening to the individual, as we do treatment, and integrate tailored prevention into our approach to breast cancer management.

Pioneer: Who is an innovative thinker who has inspired your own work — why and how?

Esserman: Andy Grove. He has been a leader in the semiconductor industry...and has encouraged the medical field to find systems-based solutions to drive knowledge turns in medicine.

Proposal Submission: Implementing Risk-Based Cancer Screening Using an Adaptive Learning Engine

Cancer screening impacts every person costs billions of dollars and is mired in rancorous debate. We are not making progress in reducing false positives, over diagnosis or potential overtreatment. We need to disrupt this practice with a fundamentally new approach, a risk-based screening approach, incorporating scientific evidence for the most effective screening frequency, and new biomarkers of risk and patient choice. By profiling tumors that arise, we will learn who is at risk for what type of cancer and facilitate tailoring treatment to biology. Using an adaptive learning model, we can accelerate and implement effective change and precision medicine. A learning system will allow us to continuously improve screening and integrate prevention while reducing the negative consequences and cost of screening immediately, not 30 years from now. The Athena Breast Health Network, a collaboration of specialists integrating research and clinical care, is uniquely positioned to champion this change.

This commentary originally appeared on the RWJF Pioneering Ideas blog.