One-Size-Fits-All Breast Cancer Screening Isn't Working—Here's What Personalized Risk Testing Changes

Personalized breast cancer screening based on individual genetic and risk factors reduces advanced cancer diagnoses by 38% compared to standard annual mammograms for all women. The WISDOM study, published in December 2025 in JAMA, involved over 28,000 women and found that stratifying screening intensity by personal risk is safe and effective—while reducing unnecessary testing for low-risk individuals.

Why One-Size-Fits-All Screening Isn't Ideal?

For decades, breast cancer screening has followed a simple formula: annual mammograms for women over 40. But this approach treats everyone the same, regardless of their actual risk. The WISDOM study challenged this by testing whether customized screening plans—tailored to each woman's genetic makeup, family history, and other risk factors—could work better. The results suggest they do.

Researchers compared two groups of women aged 40 to 74 without prior breast cancer. One group of 14,212 women received risk-based screening tailored to their individual profiles. The other group of 14,160 women continued with yearly mammograms. The key finding: risk-based screening reduced the rate of stage IIB or later breast cancer diagnoses to 30 per 100,000 person-years, compared to 48 per 100,000 person-years with annual screening. That's a 38% reduction in advanced-stage diagnoses.

How Does Personalized Risk Screening Actually Work?

The risk-based approach starts with genetic testing and risk assessment. Women in the study were tested for nine susceptibility genes and evaluated using a polygenic risk score—a calculation that combines multiple genetic variants to estimate overall risk. Researchers also used the Breast Cancer Surveillance Consortium version 2 model, which factors in age, family history, and other clinical information.

Based on these assessments, women were placed into four risk categories, each with different screening recommendations:

• Highest Risk Group: Women with a high-penetrance pathogenic variant and greater than 6% five-year breast cancer risk received alternating mammography or magnetic resonance imaging (MRI) every six months, plus counseling about risk reduction.
• Elevated Risk Group: Women in the top 2.5% of risk by age received annual mammography and risk-reduction counseling.
• Average Risk Group: Women received mammography every two years instead of annually.
• Low Risk Group: Women aged 40 to 49 with less than 1.3% five-year breast cancer risk received no screening until their risk increased to 1.3% or they turned 50.

This stratification means that high-risk women get more intensive monitoring—potentially catching cancer earlier—while low-risk women avoid unnecessary screening that could lead to false alarms and anxiety.

What About Unnecessary Biopsies and False Alarms?

One concern with any screening program is overdiagnosis: finding cancers that would never have caused harm, or triggering unnecessary biopsies based on suspicious findings that turn out to be benign. The WISDOM study tracked biopsy rates carefully. Overall, biopsy rates were similar between the risk-based group (943 biopsies per 100,000 person-years) and the annual screening group (1,029 biopsies per 100,000 person-years)—no significant difference.

However, biopsy rates varied dramatically by risk group. The highest-risk women had the highest biopsy rate at 6,647 per 100,000 person-years, which makes sense because they're being screened more frequently and intensively. The key takeaway: risk-based screening didn't increase unnecessary biopsies overall; it simply concentrated more testing on women most likely to benefit.

"Stratifying screening intensity, modality, and age to start screening by individual risk is safe," the researchers concluded, noting that the study represents "an important first step for developing risk-based screening strategies".

What's Next for Cancer Prevention?

Beyond breast cancer, cancer prevention experts are emphasizing both primary prevention—stopping cancer from developing in the first place—and secondary prevention, which focuses on catching disease at its earliest, most treatable stage. The National Cancer Institute estimates that about 40% of cancer diagnoses and deaths in the United States in 2025 were preventable.

One of the most exciting developments on the horizon is multi-cancer early detection testing. These are liquid biopsy blood tests that can detect up to 54 different cancers with a single blood draw. Researchers at West Virginia University's Department of Cancer Prevention and Control have been involved in clinical trials with these tests, which represent a potential game-changer for catching multiple cancer types before symptoms appear.

The broader message from cancer prevention experts is clear: screening doesn't prevent cancer, but it can catch it when treatment is most effective and less invasive. "By diagnosing cancer in its earliest stages, we are often able to provide less extensive local treatment such as surgery and radiation therapy where indicated, and less intensive systemic treatment," explains Stephenie Kennedy-Rea, chair of cancer prevention and control at West Virginia University Cancer Institute.

The WISDOM study's findings suggest that the future of cancer screening isn't one-size-fits-all. Instead, it's personalized—based on your genes, your family history, and your individual risk profile. For women considering breast cancer screening, talking with your doctor about your personal risk factors and whether a customized screening plan might be right for you is now an evidence-based conversation worth having.