Testing risk-based breast cancer screening

January 27, 2026

Testing risk-based breast cancer screening

Breast cancer is the second most common type of cancer among women in the United States and is the second leading cause of cancer death. Recommendations for breast cancer screening have generally been based on age rather than an individual's risk for the disease. Risk can vary significantly depending on a person's genetics, health history, and other factors.

An NIH-funded research study, called the WISDOM study, aimed to test a personalized approach to breast cancer screening. Led in part by Dr. Laura Esserman of the University of California, San Francisco, the study examined more than 28,000 women, ages 40 to 74, from all 50 states. None of the women had ever been diagnosed with breast cancer. About one-half were randomly assigned to receive annual breast cancer screening with mammograms. The other one-half received a thorough assessment of breast cancer risk based on age, genes, health history, lifestyle, and breast density.

Women in the risk-based group were divided into four risk levels. Screening schedules differed depending on a woman's risk. Those at highest risk (2%) received recommendations to get screened every 6 months, switching between MRI and mammogram. Those at "elevated" risk (8%) were asked to get an annual mammogram starting at age 40. Those with average risk (63%) were suggested to screen every two years starting at age 50. Women at lowest risk were told that screening was not recommended until age 50. The participants were followed for an average of about five years. Study results appeared in JAMA on December 12, 2025.

The researchers found that overall, risk-based breast cancer screening worked as well as annual mammography screening for detecting breast cancers. In the risk-based screening group, there were one-third fewer cancers that had advanced past a certain stage than in the annual-screening group. Within the risk-based group, the incidence of any cancer increased with risk level. But notably, there were no cancers at the specified stages in the highest-risk group. The number of breast biopsies was similar in both the annual-screening and the risk-based groups. Biopsy rates also increased with risk level.

In addition, women in the highest-risk groups received individualized counseling from a breast health specialist with recommendations for reducing risk. These included lifestyle changes and options for risk-reducing medications. Women at greatest risk in the study were more likely to use these risk-reducing medications.

The study enrolled an additional group of more than 18,000 women who opted to be observed but not be randomly assigned to a screening approach. Nearly 90% of these women chose the risk-based screening approach rather than other options. This suggests that a risk-based approach would be acceptable to most women.

Screening in both randomized groups varied from the recommendations, which could have affected the results. But the study suggests that a risk-based approach for breast cancer screening is a safe alternative to routine annual screening. Risk-based recommendations also continue to evolve. Ongoing NIH-funded clinical trials are now underway to improve personalized screening for breast cancer.

"The personalized approach begins with risk assessment, incorporating genetic, biological, and lifestyle factors, which can then guide effective prevention strategies," Esserman says.

"This is one of the first studies to offer genetic testing to all women, regardless of family history," adds study co-author Allison Fiscalini. "When used as part of a comprehensive risk assessment, these results could have a real impact on improving the safety and effectiveness of screening and prevention."

-by Yolanda L. Jones, MS, MBA

Related Links

• Researchers describe cancer trends in people under 50
• Prevention and screening drive drop in cancer deaths
• Gene variants and breast cancer risk in Black women
• Advances in breast cancer: Screening and treatment get personal
• When cancer spreads: Improving treatments for metastasis (CDC)

References

Risk-Based vs Annual Breast Cancer Screening: The WISDOM Randomized Clinical Trial. Esserman LJ, Fiscalini AS, Naeim A, Van't Veer LJ, Kaster A, Scheuner MT, LaCroix AZ, Borowsky AD, Anton-Culver H, Olopade OI, Esserman J, Lancaster R, Madlensky L, Blanco AM, Ross KS, Goodman DL, Tong BS, Hogarth M, Heditsian D, Brain S, Lee V, Blum K, Kim MO, Sabacan LP, Fergus KB, Yau C, Park HL, Parker BA, Kaplan C, Rhoads KF, Eder S, Adduci K, Matthews JB, Wenger NS, Shieh Y, Hiatt RA, Ziv E, Tice JA, Eklund M. JAMA. 2025 Dec 12:e2524784. doi: 10.1001/jama.2025.24784. Epub ahead of print. PMID: 41385349.

Funding

NIH's National Cancer Institute (NCI); Patient Center Outcomes Research Institute; Breast Cancer Research Foundation; Robert Wood Johnson Foundation; Safeway Foundation; Bright Pink; Mount Zion Health Fund; V Foundation; Sanford Health Foundation; Salesforce; Ron Conway Family; Dorian Daley and Michael Krautkramer; Charles and Ivette Esserman; Marc and Lynne Benioff.