Risk-Based Breast Cancer Screening Shows Promise as Alternative to Annual Mammograms

A groundbreaking study published in the Journal of the American Medical Association (JAMA) suggests that personalized, risk-based breast cancer screening may be as effective as the standard annual mammogram approach that has long been the cornerstone of early detection efforts.

The WISDOM randomized clinical trial evaluated more than 28,000 women aged 40 to 74 years old, dividing them into two groups: one that received standard annual mammography and another that followed a personalized screening schedule based on individual risk assessments.

Researchers calculated each woman’s cancer risk using comprehensive genetic sequencing of nine breast cancer genes along with other health factors. Based on these assessments, participants in the risk-based group received tailored screening recommendations.

Women identified as highest risk were advised to alternate between mammograms and MRI scans every six months. Those with elevated risk were recommended to continue annual mammography along with counseling. Average-risk women were guided to undergo mammograms every two years, while those deemed low-risk were advised to forgo screening until they either reached age 50 or their risk profile changed.

The study’s findings indicate that the risk-based approach did not lead to more advanced cancer diagnoses (stage 2B or higher) compared to annual screening, suggesting it could be just as safe as traditional methods. However, the personalized approach did not achieve one hoped-for outcome—reducing the total number of biopsies performed.

“[The] findings suggest that risk-based breast cancer screening is a safe alternative to annual screening for women aged 40 to 74 years,” the researchers noted. “Screening intensity matched individual risk, potentially reducing unnecessary imaging.”

The study represents a significant development in breast cancer screening strategies, which have remained relatively unchanged for decades despite advances in genetic testing and risk assessment tools. By tailoring screening frequency to individual risk, healthcare providers could potentially reduce unnecessary procedures for low-risk women while ensuring higher-risk patients receive more intensive monitoring.

However, some medical experts express caution about the study’s conclusions. Dr. Nicole Saphier, associate professor of radiology at Memorial Sloan Kettering Cancer Center, noted that the research “completely sidelines” a primary purpose of screening—detecting cancer at its earliest stages.

“If you don’t measure stage 0, stage 1 or stage 2A cancers, you can’t tell whether personalized screening delays diagnosis in a way that matters for survival and treatment intensity,” Saphier explained. She emphasized that more than 60% of breast cancers in the U.S. are diagnosed at stage 1 or 2A, where cure rates exceed 90%.

Saphier also raised concerns about classifying women under 50 as “low risk,” calling the approach “outdated” given the rising rates of breast cancer diagnoses among younger women. Recent epidemiological data has shown concerning increases in breast cancer incidence among women in their 30s and 40s, a trend that continues to puzzle researchers.

“Mammography is not without risk—radiation exposure, false positives, anxiety and potential over-diagnosis are real and should be acknowledged,” Saphier said. “But it remains the most effective, evidence-based tool for detecting breast cancer early, when treatment is most successful.”

The debate over optimal screening approaches comes as healthcare systems worldwide grapple with balancing resource utilization, patient experience, and clinical outcomes. Annual mammograms have been credited with significant reductions in breast cancer mortality over the past three decades, but they also generate numerous false positives requiring follow-up procedures.

For now, Saphier recommends that “until long-term mortality data support alternative approaches, annual screening beginning at 40 for average risk women should continue.” She also advocates for earlier risk assessment, suggesting that “women should be assessed for breast cancer risk by 25 years old to determine if screening should begin earlier.”

This study adds valuable evidence to the ongoing conversation about optimizing breast cancer screening protocols, but experts agree that long-term follow-up studies examining survival rates will be crucial before widespread changes to current guidelines can be recommended.