A new study indicates that tailoring breast cancer screening to a woman’s individual risk may be more effective than annual mammograms for all, catching cancers at earlier, more treatable stages.
Researchers reported Dec. 12 in the Journal of the American Medical Association that women assigned to risk-based screening were diagnosed with fewer advanced cancers compared to those who underwent standard yearly mammograms.
“These findings should transform clinical guidelines for breast cancer screening and alter clinical practice,” said Dr. Laura Esserman, director of the University of California-San Francisco Breast Care Center.
How the Study Worked
The study involved more than 14,000 women whose screening schedules were determined by a combination of factors, including age, genetics, lifestyle, health history, and breast density:
- 26% were at lowest risk and generally advised to start screening at age 50.
- 62% had average risk and were instructed to screen every two years.
- 8% were at elevated risk and screened annually.
- 2% were at highest risk and recommended two screenings per year, alternating between mammograms and MRI scans.
“The personalized approach begins with risk assessment, incorporating genetic, biological, and lifestyle factors, which can then guide effective prevention strategies,” Esserman explained.
These women were compared to another group of over 14,000 women who received annual mammograms regardless of individual risk. Participants were recruited between September 2016 and February 2023 and followed through September 2025.
Key Findings
The study found that risk-based screening reduced the incidence of advanced breast cancers (stage IIB or higher). Women in the risk-based group experienced roughly 30 cases of advanced cancer per 100,000 person-years, compared with 48 cases per 100,000 person-years among those in the standard screening group.
Risk-based screening also identified women at high genetic risk who might otherwise have been overlooked. About 30% of women who tested positive for high-risk genetic markers had no family history of breast cancer, meaning they would not typically qualify for genetic testing under current guidelines.
“This is one of the first studies to offer genetic testing to all women, regardless of family history,” said Allison Fiscalini, director of the Athena Breast Health Network at UCSF. “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.”
Next Steps and Expert Reactions
Researchers are now enrolling participants for a follow-up clinical trial aimed at better identifying women at higher risk for aggressive breast cancers.
However, not all experts are convinced. The American College of Radiology (ACR) cautioned that the study does not provide enough evidence to change current breast cancer screening guidelines. Many participants did not adhere strictly to their recommended screening schedules, and the total number of cancers identified was relatively small, limiting statistical reliability.
“The number of cancers found is small — likely not representative of the population,” the ACR said. “The number of patients in the highest risk group is less than 300.”
