Risk-based breast cancer screening may be more efficient than age-based guidelines

Individually-tailored risk-based screening may be a more efficient way to screen for breast cancer. Image credit – National Cancer Institute

CANCER DIGEST – Jan. 18, 2026 – Tailoring breast cancer screening to individual risk factors as opposed to relying on age guidelines may be a better way to reduce the chance of advanced cancer at diagnosis, a major screening study shows.

The WISDOM study enrolled 46,000 women from all 50 states between 2016 and 2023. The aim was to compare the current standard for screening for breast cancer based on age, to screening based on individual risk. Led by Laura Esserman, MD, MBA, of the University of California, San Francisco, the researchers assigned the women to one of four groups based on their age, genetics, lifestyle, health history, and breast density, using validated risk models.

“These findings should transform clinical guidelines for breast cancer screening and alter clinical practice,” Laura J. Esserman, MD, MBA, director of the UCSF Breast Care Center, said in a press release. Esserman is the first author of the study, published Dec. 12, 2025 in JAMA and presented the findings at the San Antonio Breast Cancer Symposium. “The personalized approach begins with risk assessment, incorporating genetic, biological, and lifestyle factors, which can then guide effective prevention strategies.”

Based on individual risk using the assessment of nine genes, a statistical estimate of a person’s genetic predisposition to cancer and a model of risk based on the Breast Cancer Surveillance Consortium the women were assigned to one of four categories of risk.

Those in the lowest risk category (26 percent) were not screened until they reached age 50 or when an algorithm predicted their risk would be that of a 50 year old. Those with average risk (62 percent) were screened every two years. Those in a higher risk group (8 percent) were screened annually. Those in the highest risk group (2 percent) were screened twice a year, once with a mammogram and once with MRI regardless of age. Women who declined to be randomly assigned to a group were enrolled in an observational group, and were allowed to choose their screening method.

Over the course of the trial, women in the higher or highest risk groups received personalized recommendations for how to reduce their risk of breast cancer, including online tools for making breast health decisions, as well as outreach from breast health specialists recommending diet, exercise and risk reducing medications.

After a median follow-up of 5.1 years statistical analysis showed that those in the highest risk category were no more likely to be diagnosed with breast cancer at stage IIB or higher, than those in the lower risk groups. In other words, the rate of stage IIB cancers was roughly the same in the high risk groups compared to the annual mammogram group. In addition the rate of unnecessary biopsies was reduced in the lower risk groups. The cumulative incidence of cancer, biopsy, mammograms, and MRIs increased as the risk category increased.

Of the women assigned to the observational group, meaning they chose their own screening schedule, 89 percent chose risk-based screening, suggesting that women prefer the individualized approach to breast cancer screening.

Overall the findings show that it is more efficient and just as effective to screen for breast cancer based on individual risk, than by using age-based guidelines. 

The WISDOM trial is ongoing and women interested in participating can enroll here.

Sources: University of California, San Francisco (UCSF) press release, and the Journal of American Medical Association, Dec. 12, 2025