5 Questions With Diana Buist

Kaiser Permanente epidemiologist on what inspires her to study breast cancer screening.

Feature Story
Buist skiing at Stevens Pass, Washington, with her daughters Bryn and Abby.
Buist skiing at Stevens Pass, Washington, with her daughters Bryn and Abby.

Diana S. M. Buist, PhD, is Senior Investigator and Director of Research and Strategic Partnerships at Kaiser Permanente Washington Health Research Institute,  an Affiliate Professor in the Departments of Epidemiology and Health Services at the University of Washington School of Public Health and an Affiliate Member of the Fred Hutchinson Cancer Research Center.

What motivated you to study breast cancer screening?

I focused on studying breast cancer screening largely because many people I know and love have been affected by the disease, starting with the mother of a close childhood friend. Since breast cancer touches everyone, understanding its epidemiology enabled me to be helpful to a lot of people. I want to help women get a better sense of their risk as individuals — and put their risk in perspective and try not to be too afraid of it.

Why is this a good place to research breast cancer?

Kaiser Permanente in Washington is part of a National Cancer Institute-funded BCSC (Breast Cancer Surveillance Consortium). In 2003, I became the leader of the BCSC’s registry here.

With collaboration comes better ideas and more patients, letting us be more precise and have more confidence in our results. Over the years, through our collaboration with the six other BCSC sites, we’ve learned so much about the benefits and potential harms of breast cancer screening, which has influenced national screening guidelines. We’ve developed risk calculators for women and health care providers to better understand their individual risk. We’re driven by wanting to educate women about their risk — and how they can work with their health care providers to decide on the best screening schedule for them based on their level of risk for the disease. Just one example: We’ve learned more about how having dense breasts can make it more difficult for radiologists to see cancer on a mammogram because tumors and dense breast tissue look the same.

What are the other ways that your work has evolved through the years?

I came here — hands down — for the unparalleled access to rich data from the continuous care of a large population of people. But I’ve stayed for the chance to design and conduct studies to help transform health and health care for our patients here and across the nation. We’ve had the opportunity to train people how to conduct research in learning health systems — something I’ve been actively involved in through a variety of different programs and that researchers are rarely taught in traditional training programs.

It’s exciting for all of us to do work that helps transform health care and improve the lives of large populations. But for that to happen, we need to do a better job of spreading the word about our findings — for instance, that every test and treatment has benefits and harms. A seminal moment happened for me in 2009. That’s when the U.S. Preventive Services Task Force issued revised recommendations, based in part on BCSC results, including that screening women aged 40-49 should include a shared-decision-making discussion to inform women about the benefits and harms of screening mammography. There was widespread backlash about this recommendation, in part because of the too-common assumption that more health care (and screening) must be better. This has led me to continue to think about how researchers need to do a better job communicating about research findings outside of academic research articles.

What else excites you most about your research?

One of the most innovative things I’ve been involved with has been the Mammography Dream Challenge, which we launched with Sage Bionetworks, a nonprofit biomedical research organization. People used Kaiser Permanente’s Washington data, artificial intelligence and deep-machine learning to try to improve breast cancer screening at a population level. The problem to be solved is that after screening, 10 percent of U.S. women are called back for diagnostic testing, with comparable cancer detection to other countries that have 3 to 5 percent recall rates. Unnecessary harms include cost, anxiety, radiation and biopsies.

Buist hiking in Central Oregon with her mother, father, and sisters: Drs. Sonia, Catriona, Alison, Neil, and Diana Buist (L-R).

Buist hiking in Central Oregon with her mother, father, and sisters: Drs. Sonia, Catriona, Alison, Neil, and Diana Buist (L-R).

What keeps you going outside of work?

I love hiking, skiing and traveling with my husband, daughters, sisters and parents. Both my parents have been long-time physician-researchers at Oregon Health & Science University in Portland, Oregon. My mother and father are from the United Kingdom, and that’s why I have two middle initials, U.K. style, instead of just one.

Our parents’ interests, and what they exposed us to — especially in the developing world — really drive us all. For instance, my mother founded the American Thoracic Society’s international course that trains physicians in emerging countries how to do research, and I’ve been teaching that course with her during my vacations since 1997.

It’s no accident that we all work to improve health outcomes. We have a dream that we’ll write an article together with the citation “Buist, Buist, Buist, Buist and Buist.”