Enrolling in business school while at Stanford Medical School might seem to be a near-impossible task reserved only for the most ambitious. Yet, Dr. Laura Esserman did exactly that, and with an infant daughter at home. While attending Stanford Business in the early 1990s, Dr. Esserman saw the potential for applying Silicon Valley principles of learning and problem-solving to how doctors care for patients. Specifically, the practice of rapid iteration built around cycles of testing, learning, and refining made a strong impression on her. “The most important thing about any of this is not just to believe, but to test it and to learn. You have to learn, you have to innovate,” she recalled. “I really thought, ‘There’s no reason why we can’t do that in medicine.’” So Esserman launched the Athena Breast Health Network, a University of California-wide learning model for integrated care and research. “There is an incredible community of innovative clinicians across the Athena Network — all bringing their skill and insight to find a better future,” she explained. And now she’s heading up a massive, five-year study to find a better approach to breast cancer screening and prevention. At Dreamforce 2015, Dr. Esserman and her team announced their 100,000-woman campaign, the Wisdom Study.
Combining best practices from medicine with App Cloud, the Wisdom Study is built around an idea called precision medicine. “Precision medicine means that you’re not going to treat people as one-size-fits-all,” Dr. Esserman explained. Rather than relying on one treatment plan — often based on the worst-case scenario — this approach to patient care takes into account individual variability in genes, differences in biology of cancers that arise, environment, lifestyle, and the performance of our clinical interventions.
Breast cancer is not one disease, and not all breast cancers are the same. Some are not life-threatening, while others are highly aggressive and often difficult to detect via mammogram. Current research shows that more than 20% of newly diagnosed cases of breast cancer in the U.S. are ductal carcinoma in situ (DCIS) or stage 0, cancers that may not require the aggressive treatments currently prescribed. The goal of the Wisdom Study is to investigate whether a personalized approach to breast cancer screening is as safe and effective as the current standard practice of annual mammograms.
In order to gather a meaningful dataset, the Wisdom Study researcher set out to recruit 100,000 women between the ages of 40 and 74 to participate. Recording and analyzing detailed data from that many people in real time requires an innovative technology partner ready and willing to collaborate. Using App Cloud, the Athena Breast Health Network created a learning platform to recruit the participants, record their individual histories and medical profiles, and glean insights to be reported back to practitioners as the study progresses. “Every person who comes in front of me is going to be part of this bigger process of learning,” Dr. Esserman said. “And now I can not only profile that person on an individual basis, but I can also follow them over time.”
App Cloud also empowers academic groups to work with larger datasets than they could otherwise. “If the Athena Network wanted to run a trial of 100,000 people,” said Dr. Esserman, “it would not be possible without automation.” Athena selected Salesforce as a partner in 2010, which has enabled Athena to get closer to its goal of precision medicine over the past five years.
Carlie Thompson, resident physician at the UCSF School of Medicine, pointed out that without the medical and technology communities coming together in the spirit of innovation, the Wisdom Study wouldn’t be possible. “Before, we didn’t have the information technology tools to collect this big data, and to analyze and use the data to make changes,” she said. “Now, between the scientific progress and the available tools we’re finally able to make it all happen in sync.” Getting the Wisdom Study up and running was no small feat, but it’s only the beginning of a journey toward a new way of treating breast cancer, and approaching medical care and research at large. “We haven’t had the opportunity to integrate all of the advances in breast cancer biology and our understanding of risk of breast cancer into screening and prevention. Now is our chance,” Dr. Esserman explained. “That’s what the Wisdom Study really is all about.“