One-Size-Fits-All Cancer Screening Is Outdated—Here's What's Replacing It

A groundbreaking study involving 46,000 women suggests that breast cancer screening should be tailored to each person's individual risk rather than following the same schedule for everyone. The research found that matching screening frequency to personal risk levels reduced advanced cancer diagnoses while ensuring women still received appropriate care.

How Does Risk-Based Screening Actually Work?

The WISDOM study, coordinated by the University of California San Francisco, compared traditional annual mammography with a personalized approach. Researchers used validated risk models to group participants into four categories based on age, genetic information, lifestyle factors, health history, and breast density.

Here's how the personalized screening schedule worked:

• Lowest Risk (26% of participants): Advised to delay screening until age 50 or until their risk reached that of a typical 50-year-old
• Average Risk (62% of participants): Recommended screening every two years instead of annually
• Elevated Risk (8% of participants): Continued with annual mammograms as currently recommended
• Highest Risk (2% of participants): Received screening twice yearly, alternating between mammography and magnetic resonance imaging (MRI), regardless of age

What Makes This Approach More Effective?

The personalized screening strategy didn't lead to higher rates of late-stage cancer diagnoses, which was a key concern. "These findings should transform clinical guidelines for breast cancer screening and alter clinical practice," said Laura J. Esserman, director of the University of California San Francisco Breast Care Center and the study's first author.

Women at higher risk also received customized prevention guidance, including access to online decision-making tools and direct contact with breast health specialists. Recommendations covered lifestyle changes like improving diet and increasing physical activity, plus discussions about risk-reducing medications.

Why Genetic Testing Could Change Everything

One of the study's most surprising findings involved genetic testing. Researchers discovered that 30% of women who tested positive for genetic variants linked to higher breast cancer risk had no family history of the disease. Under current guidelines, many of these women wouldn't typically qualify for genetic testing.

The study evaluated well-known genetic variants like BRCA1 and BRCA2, plus smaller DNA changes combined into a polygenic risk score. This comprehensive genetic approach improved risk prediction accuracy and resulted in 12% to 14% of participants being reassigned to different risk categories.

"This is one of the first studies to offer genetic testing to all women, regardless of family history," explained Allison S. Fiscalini, director of the Athena Breast Health Network and the WISDOM study.

Perhaps most telling about patient acceptance: among women who weren't randomly assigned to a screening group, 89% chose the risk-based approach over traditional annual screening. "Shifting resources from lower-risk women to higher-risk women is an efficient, effective approach to screening for and preventing breast cancer," said co-author Jeffrey A. Tice, a University of California San Francisco professor specializing in breast cancer risk assessment.

The research team is continuing to refine their approach through WISDOM 2.0, focusing on better identifying women at risk for aggressive breast cancers and providing them with tailored screening and prevention strategies.