A large study indicates that tailoring breast cancer screening to individual risk factors is safer and more effective than routine annual mammograms for all women. Researchers from the WISDOM study analyzed data from 46,000 participants and found reduced rates of advanced cancers without compromising safety. The approach incorporates genetics, health history, and lifestyle to customize screening frequency.
The WISDOM study, coordinated by the University of California, San Francisco (UCSF), compared traditional age-based mammography with a risk-stratified strategy. Launched in 2016, it has enrolled over 80,000 women, including those as young as 30 to detect early risks from genetic variants.
Participants were categorized into four risk groups using validated models that consider age, genetics, lifestyle, health history, and breast density. The lowest-risk group (26% of participants) delayed screening until age 50 or when risk matched a typical 50-year-old. Average-risk women (62%) screened every two years, elevated-risk (8%) annually, and highest-risk (2%) twice yearly, alternating mammography and MRI.
Higher-risk women received tailored prevention advice, including diet improvements, exercise, and medication discussions, plus access to online tools and specialists. Crucially, this method did not increase late-stage diagnoses. Among non-randomized participants, 89% chose the personalized approach.
"These findings should transform clinical guidelines for breast cancer screening and alter clinical practice," said Laura J. Esserman, MD, MBA, director of the UCSF Breast Care Center and lead author. The study, published December 12 in JAMA and presented at the San Antonio Breast Cancer Symposium, revealed that 30% of women with genetic variants linked to higher risk had no family history, challenging current testing guidelines.
Polygenic risk scores refined predictions, reassigning 12% to 14% of participants to different categories. "Shifting resources from lower-risk women to higher-risk women is an efficient, effective approach," noted co-author Jeffrey A. Tice, MD.
"This is one of the first studies to offer genetic testing to all women, regardless of family history," added Allison S. Fiscalini, MPH, of UCSF. Researchers are advancing with WISDOM 2.0 to further target aggressive cancers.
