A major trial suggests tailoring screening to individual risk is safe and might reduce unnecessary tests
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A large U.S. clinical trial found that risk-based breast cancer screening where screening frequency is tailored to each womans individual risk is just as safe as yearly mammograms for catching advanced cancers.
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Women were grouped using genetics, lifestyle, and clinical factors; those at highest risk got more intensive screening, while lower-risk women had less frequent imaging.
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Most women preferred risk-based screening when given the choice, and the approach led to fewer mammograms overall without increasing dangerous late-stage cancers.
For decades, routine breast cancer screening in the U.S. has largely meant annual mammograms starting in middle age a one-size-fits-all approach based mostly on age.
But what if screening could be smarter?
Thats exactly what researchers set out to test in the WISDOM trial, a large study coordinated by the University of California, San Francisco (UCSF) that asked a simple question: Can we use individual risk profiles to decide who needs what kind of screening?
Published in JAMA and presented at a major cancer symposium, the trial enrolled tens of thousands of women ages 4074 and compared traditional yearly mammograms with a personalized plan driven by each womans unique risk factors including genetics, breast density, lifestyle, and other health details.
These findings should transform clinical guidelines for breast cancer screening and alter clinical practice, Laura J. Esserman, M.D., MBA, director of the UCSF Breast Care Center, said in a news release. The personalized approach begins with risk assessment, incorporating genetic, biological, and lifestyle factors, which can then guide effective prevention strategies.
How the study worked
Instead of automatically giving everyone a mammogram every year, researchers built risk scores that placed participants into different screening pathways.
Women in the highest risk group based on things like genetic predisposition or very high calculated risk were advised to get imaging every six months, switching between mammograms and MRI.
Those with elevated risk still got annual mammograms plus counseling on ways to lower their risk. Most women fell into the average risk category and were recommended to have mammograms every two years. At the lowest end, women with especially low estimated risk were told they could safely delay screening until later often up to age 50 unless their calculated risk rose.
This design also offered tools for personalized risk reduction, like diet and exercise guidance or conversations about medications that may lower cancer risk. Women who chose not to be assigned randomly could pick their own screening approach in an observational group and most picked the risk-based route.
What the results showed
After about five years of following more than 28,000 women, the core finding was that the risk-based screening plan was as safe as traditional annual mammography.
Researchers looked especially at the number of advanced cancers (stage IIB or higher) detected and found that the risk-based group did not have more of these serious cases in fact, the rate was slightly lower across the study period, meeting the trials main goal of noninferiority.
Interestingly, women in the risk-based strategy had fewer mammograms overall but similar rates of biopsies and cancer detection meaning the personalized approach didnt miss cancers or lead to more invasive follow-ups even with less frequent imaging for many.
Whats more, when given the choice, a large majority of participants opted for the risk-based strategy, showing that many people appreciate tailoring screening to their specific profile.
Posted: 2026-03-04 17:53:43
