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Researchers at Hadassah hospitals are advancing breast cancer care through innovative studies that address healthcare disparities and explore how artificial intelligence (AI) can help deliver more personalized treatment.
One area of research has found that ultra-Orthodox and Arab women from East Jerusalem are diagnosed with breast cancer at a much more advanced stage and experience worse outcomes than the general population. The research is led by Dr. Shani Paluch-Shimon, director of the Breast Oncology Department at the Hadassah Medical Organization (HMO), and psycho-oncologist Dr. Michal Braun, head of the psychology service at the Breast Health Center of Excellence at Hadassah Hospital Ein Kerem.
Their ongoing, longitudinal prospective study, funded by the Breast Cancer Research Foundation (BCRF), examines healthcare disparities among different groups of women in Jerusalem.
"In Israel, we are the only center that does patient-level healthcare disparity research into breast cancer management and outcomes," said Dr. Paluch-Shimon.
Some of the research findings are surprising. Despite poorer breast cancer outcomes, ultra-Orthodox women report better psychosocial outcomes, including quality of life, mental health and spiritual wellness, than other groups. Arab women, by contrast, report higher levels of depression, loneliness and anxiety.
"The research is significant as it can help us tailor what we do and what we provide for our patients," said Dr. Paluch-Shimon. "We try to understand what the systemic values and cultural habits are so we can think of public health intervention as well."
Dr. Paluch-Shimon and Dr. Braun identify language barriers, cultural modesty norms and communication gaps with medical staff as key obstacles for Arab and ultra-Orthodox Jewish women. Both groups also face challenges within their communities when it comes to expressing emotions and speaking openly about illness. For both groups, "God is a very strong attachment figure," explained Dr. Braun.
Dr. Braun added that "while ultra-Orthodox women are a minority group, they are a strong group as they have community members and informal support systems helping bridge gaps for them."
Dr. Paluch-Shimon and Dr. Braun emphasize the importance of working with community doctors to address cultural and language barriers between Hadassah hospitals and primary care providers in East Jerusalem.
Dr. Braun said the team is now looking to expand this research to other communities in Israel to see if the Jerusalem model holds.
While breast cancer care is becoming more culturally adaptive, it is also becoming more personalized and effective for each patient. Screening, diagnosis and treatment must be adapted to the unique genetic and molecular features of both the patient and their specific tumor.
Artificial intelligence is an important new tool that accelerates personalized breast cancer care by analyzing complex genetic, imaging and tissue data to help doctors detect tumors earlier, predict precise treatment responses and tailor therapies to each patient's unique biology.
"Personalized medicine and artificial intelligence are the future of breast cancer treatment," said Dr. Paluch-Shimon.
She is leading a separate research project with the pathology team to help identify BRCA mutations. BRCA1 and BRCA2 are tumor-suppressor genes responsible for repairing cellular DNA damage. Testing for mutations in these genes is vital because the results can affect treatment, surgical management, screening and follow-up for additional breast cancers and other malignancies, as well as have implications for family members.
Dr. Paluch-Shimon's team is examining pathology slides of women already diagnosed with a BRCA mutation to develop an AI-based model that aims to identify patients who may carry a BRCA mutation through analysis of their pathology slides. Traditional genetic counseling and testing processes can delay access to genetic data.
"This saves a lot of time and informs us which patients should be fast-tracked for testing," Dr. Paluch-Shimon said. "We're trying to see whether we can predict response to treatment via this model as well."
While the project is still at an early stage, its outcome could have global impact. "Physicians in low-resource countries could simply scan a slide and send it overseas for the model to predict [the likelihood of a BRCA mutation]. It may not prevent us from needing to do a blood test, but it may also help us identify which patients are likely to have a BRCA mutation and accelerate testing," she added.
Dr. Paluch-Shimon also emphasizes the importance of tailoring breast cancer risk assessment and screening to each patient's individual needs.
"We encourage all women to fill a questionnaire and do a screening to see what their risk is."
Gesturing to a shelf in her office filled with photos of her patients' babies, Dr. Paluch-Shimon shares some happy news: "Most women living with breast cancer or breast cancer survivors who want to have children will be able to do so. These photos are the happy proof."
