Karla Kerlikowske, MD is Professor of Medicine and of Epidemiology and Biostatistics at UCSF, Director of the Women Veterans Comprehensive Health Center at the San Francisco Veterans Affairs Medical Center and Principal Investigator of the NCI-funded San Francisco Mammography Registry and co-Principal Investigator of the Program Project grant “Biological Basis of Breast Density and Breast Cancer Risk.” She is an internationally recognized expert on breast cancer screening, ductal carcinoma in situ (DCIS) and mammographic breast density. 415-750-2093; Karla.Kerlikowske@ucsf.edu

Breast Cancer Research Program

Dr. Kerlikowske’s research program focuses on the epidemiology of invasive breast cancer and ductal carcinoma in situ; patient and physician factors that influence the accuracy of screening mammography; improving breast cancer risk assessment and breast cancer detection in high risk women; epidemiologic, biologic and genetic studies of breast density; and predictors of breast cancer recurrence.

Screening mammography

• To maximize the potential benefit and minimize potential harms, women should have 10 mammograms between ages 50 and 69 years.
  
• The accuracy of mammography is highest among women ages 50 and older with primarily fatty breast tissue and lower among women less than 50 years of age with dense tissue.
  
• Wide variability in interpretation of mammography by radiologists has continued, even after audit and continuing medical education requirements for radiologists were implemented by the Mammography Quality and Standards Act. We are studying means to assess radiologists’ interpretative skills and developing interventions to improve interpretative skills.
  

Ductal carcinoma in situ (DCIS) of the breast

• DCIS is a premalignant breast lesion that begins in the milk ducts. DCIS has increased 550% between 1973 and 1992 and now accounts for 20% of all newly diagnosed cases of breast cancer in the United States. An estimated 62,000 cases will be diagnosed in 2006.
  
• DCIS has a 10-year mortality of 1-2%, yet it is treated like Stage I invasive breast cancer.
  
• Dr. Kerlikowske is conducting a large population-based study of women with DCIS that is examining clinical and histopathology characteristics and molecular markers that can more accurately identify women with DCIS in whom cancer will develop. The ability to identify these women could avoid over treating the majority of women with DCIS and focus aggressive treatment on those at highest risk.
  

Breast Density and breast cancer risk

• Risk factors for invasive breast cancer and DCIS are similar with older age and family history of breast cancer associated with the highest risk. Yet, traditional risk factors (reproductive history, family history of breast cancer, age at menopause and age at menarche) account for less than 50% of all breast cancer cases.
  
• Breast density is one of the strongest risk factors for breast cancer. Women with more dense breasts on mammograms have a much higher risk for breast cancer than those with fatty breasts, but measurement of breast density on mammography examinations is not very accurate.
  
• We are studying several methods to improve the measurement of breast density and developing risk models that incorporate breast density measures to better estimate a woman's risk of breast cancer. In addition, we are examining biologic markers in woman with high breast density to determine their association with breast cancer risk.
  

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