New study questions annual mammograms for most women; risk-based screening shows comparable safety
A JAMA-published trial of more than 28,000 women finds that risk-based breast cancer screening tied to individual risk may be as safe as annual mammography, though not all expected reductions in procedures occurred.
A major U.S. study questions whether annual mammograms are necessary for most women, testing a risk-based approach that tailors imaging to individual cancer risk. The trial, conducted under the WISDOM framework, enrolled more than 28,000 women ages 40 to 74 and compared risk-guided screening with standard annual mammography.
Researchers estimated risk using genetic data from sequencing of nine breast cancer genes and other health factors. Based on risk, participants were assigned to four screening paths: those at highest risk were advised to alternate between mammograms and MRI every six months; those at elevated risk were told to have an annual mammography plus counseling; average-risk women were scheduled for mammograms every two years; and low-risk individuals were advised to defer screening until risk increased or they reached age 50.
The study found that risk-based screening did not result in more cancers diagnosed at advanced stages (stage 2B or higher) compared with annual screening, indicating that the risk-based approach is a safe alternative for women aged 40 to 74. The researchers said screening intensity was aligned with individual risk, potentially reducing unnecessary imaging.
However, the approach did not reduce the total number of biopsies. Among higher-risk participants, more screening procedures and biopsies occurred, with more cancers detected, while lower-risk participants underwent fewer procedures.
Health experts cautioned that the findings do not fully answer whether risk-based screening improves detection at the earliest and most treatable stages. Fox News medical contributor Dr. Nicole Saphier said the study is important but does not resolve whether early-stage cancers are being missed or delayed. She argued that long-term mortality data will be needed before changing guidelines and that annual screening remains the standard for average-risk women starting at age 40; risk assessments should begin earlier for some populations.
Saphier noted that mammography carries risks such as radiation exposure, false positives and potential over-diagnosis, but remains the most effective tool for detecting breast cancer early when treatment is most successful. She also stressed that labeling women under 50 as low risk is outdated given rising cancer rates among younger women and that risk assessment could inform when screening starts.
In context, clinicians emphasize that more than 60% of breast cancers in the United States are diagnosed at stage 1 or 2A, where cure rates exceed 90%. The trial’s findings suggest risk-based screening could supplement, rather than replace, conventional screening while guidelines evolve.
Until long-term mortality data support alternative approaches, many experts say annual screening beginning at age 40 for average-risk women should continue, with risk-based screening offered as an option under careful counseling and ongoing monitoring.