Data from the University of Hawaii Cancer Center tells us that breast cancer is not only the most common cancer among women (comprising 34% of cases), but has the second-highest mortality in Hawaii. (Only lung cancer deaths are higher.)

Identifying who is at high risk of developing invasive breast cancer, determining how to detect it as soon as possible and even preventing it is the mission of John Shepherd, chief scientific officer of the UH Cancer Center and director of the Hawai‘i and Pacific Islands Mammography Registry, referred to as HIPIMR.

“Catching cancer early saves lives,” said Shepherd.

Doctors can’t predict exactly what will happen in any person’s case, but according to statistics from the American Cancer Society, the earlier the cancer is diagnosed, the better the chances are that the patient will be alive after five years.

I had a chance to speak to Shepherd recently to discuss what he’s discovered from the data he’s collected at HIPIMR.

Question: Can you describe the goals of your study?

Answer: HIPIMR is a registry that keeps track of who develops breast cancer, but as importantly, who doesn’t. We would like to monitor all women in Hawaii and try to do that by partnering with our medical facilities and the Hawaii Tumor Registry. Currently, we monitor breast cancer outcomes on over 125,000 women, and this number grows each year. If we can better identify who is at high risk, we can suggest risk reduction strategies where they do the most good.

Q: What metrics concern you about prevalence of breast cancer in the Aloha State?

A: We have a higher advanced-­stage rate that is tied to higher mortality. Risk models developed in the continent or in Europe don’t represent breast cancer risk in Hawaii’s women very well. This is mainly due to the disparity in incidence we see that can be seen between race/ethnicity groups. For example, Japanese and Native Hawaiians have the highest cancer incidence, but mortality is twice as high in Native Hawaiians, compared to Japanese Americans.

Q: What can women do to prevent breast cancer?

A: There are common breast cancer risk factors, but only a few are modifiable. Women increase in breast cancer risk with advanced age, a first-degree relative with breast cancer, dense breast and a high (body mass index, in the obese range). Factors that are considered protective are having a child before age 30, and even surgical menopause. But other than BMI, these risk factors are not really something you can modify. Any reduction in BMI reduces your breast cancer risk.

Q: Are there drugs to help lower a person’s risk of developing cancer or keep it from coming back?

A: For those at high risk, chemopreventions should be considered. In total, there are over a dozen to choose from, depending on a person’s tolerance and specific situation. Ultimately, women at very high genetic risk sometimes turn to bilateral mastectomy to prevent breast cancer. This extreme prevention decision is very unfortunate but is the decision for some younger women that have high genetic risk. You may recall that Angelina Jolie had an estimated 87% lifetime risk of breast cancer and decided to have a bilateral mastectomy.

Q: What have been the major findings to come out of the study so far?

A: HIPIMR has been funded by the (National Institute of Health’s) National Cancer Institute for only a year. Our biggest accomplishment has been to convince our major health care providers to use our standardized HIPIMR breast health questionnaire. We want all mammography centers to use the questionnaire so that we can more quickly solve the questions around risk. We have also been developing artificial intelligence models to be used with portable ultrasound wands for early detection of breast cancer in rural areas of the island where mammography is less available.

Q: What are you planning next?

A: Once we understand risk for invasive cancer in general, we will ask what are the reasons that some women develop advanced-­stage cancer and some don’t. We think that staging is modifiable with better education on the importance of regular screening, paying attention to changes in the breast like feeling a new lump. But how you intervene to reduce staging will probably be specific to each island and locality in the Pacific. We plan on presenting our findings to the community and asking them to partner with us to determine the best way to address the issues we find cause advanced staging.

Rob Kay, a Honolulu-based writer, covers technology, health and sustainability for “Tech View” and is the creator of fijiguide.com. He can be reached at Robertfredkay@gmail.com.