Diana L. Miglioretti, PhD, Kaiser Permanente and University of California, Davis shares what inspires her to study cancer screening.
We spoke with Diana L. Miglioretti, PhD, senior investigator, Kaiser Permanente Washington Health Research Institute; and Dean’s Professor of Biostatistics in the Department of Public Health Sciences, School of Medicine at the University of California, Davis.
It’s personal. I understand the potential benefits of regular screening for cancer. My mother’s grandmother died from late-detected breast cancer before screening was widely available and known to be important. My mother’s mother and sister also had the disease, and I grew up thinking I had a 100 percent risk of developing it. But after studying biostatistics, my perspective changed. Since my aunt, no one in my family has had breast cancer, and we don’t have genes that increase our risk for the disease. So, either the genes weren’t passed down or my family’s cluster of diagnoses was an unlucky fluke.
My interest in cancer screening led me to Kaiser Permanente Washington Health Research Institute, which has been such a valuable place for me to work. The Institute is part of the National Cancer Institute-funded Breast Cancer Surveillance Consortium, which I now co-lead. It is a network of breast imaging registries across the country that has contributed to the evidence about screening’s benefits and harms.
I’m motivated by figuring out how to use diagnostic imaging thoughtfully and minimize unnecessary harms from it, including unneeded exposure to ionizing radiation. CT scanning is extremely valuable for diagnosing disease – but one CT scan can deliver as much ionizing radiation as 200 X-rays, and a few CTs can deliver as much exposure as has been linked to a small increase in cancer risk. Experts believe 1 in 3 U.S. CT scans in the U.S. aren’t medically necessary, and often, another type of imaging test that doesn’t use ionizing radiation, like ultrasound or MRI, could be substituted.
I want to find ways to reduce overuse of screening, because of the cascade of other tests, anxiety, inconvenience, cost, and risk that can come from false-positives (when disease seems present, but isn’t), or incidental findings (when a test for one disease detects unrelated abnormalities that then may require additional follow-up testing). For instance, our JAMA Internal Medicine paper published recently reported that women with simple ovarian cysts aren’t at increased risk for ovarian cancer, so follow-up imaging isn’t needed, unless a woman feels pain.
I’m really excited about working toward personalizing screening for cancer. Certain people might benefit from more screening, and some might do just as well with less. I’m helping evaluate the less-versus-more intensive strategies for follow-up on lung nodules. And in a Breast Cancer Surveillance Consortium study, we’re trying to target which women might need to be screened more intensively for breast cancer — and which ones might not need so much screening.
My husband and I live in the mountains in Truckee, California, in the Lake Tahoe area. We cook together almost every night, using whole organic foods. I bake naturally leavened, whole-grain bread. Kindred, our Australian shepherd, helps us stay active. We enjoy the outdoors nearly every day, mountain biking, hiking, rock climbing, or skiing.