Two UChicago Medicine researchers received a grant from the Gray Foundation to develop and test an innovative screening tool for women who carry harmful BRCA gene mutations. The grant is part of the Gray Foundation’s ongoing Team Science program, which funds BRCA-related collaborative research.
Milica Medved, PhD, research associate professor in the Department of Radiology, and Kathryn Mills, MD, assistant professor of Obstetrics and Gynecology, will lead a team of researchers combining technical and clinical expertise to address a current gap in cancer screening and, potentially, to boost the screening capabilities of community hospitals where technology may be older and less effective.
Combining screenings for improved diagnosis
Every person has two versions of the BRCA genes, which produce proteins that help repair damaged DNA. When the genes function properly, they form part of the body’s defense system against cancer. However, patients with a harmful BRCA gene mutation face a considerably elevated risk for breast, ovarian, prostate, and pancreatic cancers.
Currently, women who carry the mutation receive regular magnetic resonance imaging (MRI) screenings for breast cancer, which has proven effective. However, these same women are not well served by current screening techniques for ovarian cancer, which include ultrasound imaging and a blood test. These screenings have proved less effective at catching ovarian cancer early, which leads to poor survival outcomes. Ovarian cancer caught at an early stage has a five-year survival rate of over 90 percent, but if detected at a late stage, the survival rate drops to around 30 percent.
Currently, MRI screenings are not typically offered for ovarian cancer because of high costs, long scan times, and uncertain benefits. Poor screening options for ovarian cancer mean that women with the BRCA mutation often face the choice of whether to have the drastic preventive surgery to remove their ovaries and fallopian tubes, leading to early menopause and lower quality of life.
Since women with the BRCA mutation already receive regular MRI screenings for breast cancer, Medved and Mills proposed a study using a new technology, augmented with AI tools, that can add ovarian cancer screening to an already scheduled MRI breast cancer screening exam.
Medved, a medical physicist specializing in MRI, worked to enable a flexible coil technology in a way that will allow a patient to undergo MRI screening for ovarian cancer at the same time as her breast MRI.
“The technology allows the additional screening to occur in the same session without the patient being repositioned, and new AI tools can help enhance the scans and ensure that the additional screening can be performed in ten to 15 minutes,” said Medved, who has over 25 years of experience developing and testing methods for MRI cancer screening and imaging, as well as 16 years of experience supporting clinical trials involving MRI.
“Patients with the BRCA mutation are not well served by current screening tools, which generally fail to identify ovarian cancers until they are in an advanced stage. The vast majority are still found at an advanced stage,” said Mills, a gynecologic oncologist specializing in hereditary ovarian cancer and the care of patients with BRCA mutations. “My clinical practice gave me insight into the need for more integrated, sensitive imaging approaches. Finding more ovarian cancer early would be literally life-changing for our patients.”
Using artificial intelligence (AI) to enhance screening technologies
The AI tools being tested in this study have the potential to both improve image quality—making the scans more effective at catching early-stage cancers—and efficiency—allowing the additional screenings to occur in a single session. Improving both speed and quality in MRI scans can benefit patients beyond UChicago Medicine. The team led by Medved and Mills will also investigate whether the flexible coil technology together with the AI tools would work with lower-field strength scanners typically found in community hospitals. This integrated screening technique would then be available to communities far outside the range of large academic medical centers with advanced technology.
Broader impact
The study led by Medved and Mills is part of the Gray Foundation’s international Team Science program, which funds research in prevention, early detection, and interception of BRCA-related cancers, as well as the application of advances in technology and AI to cancer research. This is a collaborative project bringing together a team of Technion and University of Pennsylvania researchers led by Moti Freiman, PhD, Karthik Sundaram, MD, PhD, and Dylan Tisdall, PhD. Data generated by these studies will go into the Gray BRCA Pre-Cancer Atlas, a resource capturing data on the molecular, genetic, and physiological changes occurring at the earliest signs of BRCA-associated cancer collected by Gray-funded research teams. Access to the Atlas, especially as researchers harness new AI tools, offers teams around the world the data needed to generate and test ideas for new detection tools and improved treatments.
