For many years, breast cancer screening has followed a simple rule: most women are advised to start having yearly mammograms at a certain age, usually around 40 or 50.
This approach assumes that all women face roughly the same risk of developing breast cancer. However, scientists have long known that this is not true.
Some women have a much higher risk because of their genes, family history, lifestyle, or breast tissue type, while others have a much lower risk.
A large new study suggests that changing how breast cancer screening is done could lead to better outcomes for women.
The findings are published in JAMA.
The study, led by researchers from the University of California, San Francisco, tested a new approach that focuses on individual risk instead of age alone. This research was part of the WISDOM study, one of the largest breast cancer screening studies ever conducted in the United States.
The first phase included about 46,000 women from across the country. The results were published in a major medical journal and presented at an international cancer conference.
Instead of recommending the same screening schedule to everyone, the researchers first assessed each woman’s personal risk of developing breast cancer.
This assessment included information about age, genetic test results, personal and family health history, breast density, and lifestyle factors such as weight and activity levels. Using this information, women were matched to a screening plan designed to fit their individual level of risk.
Women at the lowest risk were advised to delay screening until later in life, since early and frequent testing may not benefit them and could lead to unnecessary stress or procedures. Women with average risk were advised to have mammograms every two years instead of every year.
Women with higher risk were advised to have annual screening, and those at the very highest risk were offered even more careful monitoring, including both mammograms and MRI scans.
The study found that this personalized approach did not lead to more advanced or dangerous cancers being missed. In other words, women who had less frequent screening because they were at lower risk did not end up with worse outcomes.
At the same time, women at higher risk received more focused attention, which may help detect aggressive cancers earlier.
An important part of the study involved genetic testing. Many women carry genetic changes that increase their risk of breast cancer, but do not know it. The researchers discovered that about one-third of women who tested positive for higher-risk genetic changes had no known family history of breast cancer.
Under current guidelines, these women would likely never have been offered genetic testing. This finding shows that relying on family history alone can miss many people who are actually at higher risk.
The study also used newer genetic tools that look at many small genetic changes together, rather than focusing only on well-known genes like BRCA1 and BRCA2.
When these smaller changes were combined into a single risk score, doctors were able to predict risk more accurately. This led to some women being moved into higher or lower risk groups, allowing their screening plans to be adjusted.
Another important finding was how women felt about this approach. Many participants were allowed to choose whether they wanted to follow the traditional screening plan or the risk-based plan.
Nearly nine out of ten women chose the personalized option. This shows that women are open to, and even prefer, screening plans that are tailored to their individual needs rather than a one-size-fits-all rule.
The researchers also offered women with higher risk personalized advice on how to lower their chances of developing breast cancer.
This included guidance on healthy eating, exercise, and in some cases, medications that can reduce risk. By focusing resources on women who need them most, this approach may improve prevention as well as early detection.
Overall, the study suggests that breast cancer screening could be safer, more effective, and more efficient if it starts with understanding each woman’s individual risk. It challenges long-standing screening guidelines that are based mainly on age and supports a move toward more personalized healthcare.
When reviewing these findings, it becomes clear that risk-based screening has strong advantages. It avoids unnecessary testing for low-risk women, reduces anxiety and false alarms, and directs medical attention where it is most needed.
At the same time, it improves the chance of finding serious cancers early in women who face higher risk. While longer follow-up is still needed, this study provides strong evidence that personalized screening could become the future standard of care for breast cancer prevention.
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