A new study indicates that personalized, risk-based breast cancer screening could be as effective—and in some cases more beneficial—than standard annual mammograms. The findings, presented at the San Antonio Breast Cancer Symposium and published in JAMA, could reshape how women are screened for the disease.
The research, led by Dr. Laura Esserman, a breast-cancer surgeon and director of the University of California San Francisco Breast Care Center, was conducted as part of the WISDOM (Women Informed to Screen Depending on Measures of Risk) study. Launched in 2016, WISDOM enrolled more than 28,000 women between the ages of 40 and 74, none of whom had breast cancer at the outset. Participants were randomly assigned to either a traditional annual mammogram schedule or a personalized screening plan based on individual risk factors.
The first analysis, which followed participants for around five years, found that alternative screening schedules—including less frequent or more intensive monitoring—were comparable to yearly mammograms in detecting cancer. Notably, the number of Stage 2B breast cancers, which carry a higher mortality risk, was one-third lower in the risk-based group. “Even I am amazed by these results,” said Esserman.
WISDOM’s approach incorporates genetic testing for nine breast cancer-related genes, as well as other risk factors such as breast density, age, personal medical history, and family history. Based on these factors, women were placed into one of four screening regimens. Those at highest risk received alternating mammograms and MRIs every six months, elevated-risk women had annual mammograms, average-risk women were screened every two years, and lowest-risk women received mammograms only if their risk score changed.
The study also highlighted the limitations of relying solely on family history to assess risk. Around 30% of participants with high-risk genes had no known family history of breast cancer, underscoring the importance of broader genetic testing.
Esserman said the findings demonstrate that risk-based screening can safely guide detection while reducing unnecessary testing and over-treatment. She also noted that women’s preferences have shifted, particularly following the COVID-19 pandemic, with many showing interest in tailored screening plans rather than uniform schedules.
The results support a growing body of research questioning whether aggressive treatment is needed for early, low-grade lesions such as DCIS. The next phase of WISDOM will focus on whether personalized screening can help prevent cancer, rather than simply detect it.
“Smarter screening is the goal,” said Esserman. “This study shows that tailoring screening to a woman’s risk can improve outcomes while avoiding unnecessary procedures. It’s an important step toward a more precise approach to breast cancer care.”