New study questions whether annual mammograms are necessary for most women

A new randomized trial published in the Journal of the American Medical Association suggests that a risk-based approach to breast cancer screening may be as safe as annual mammography for many women aged 40 to 74. The WISDOM trial enrolled more than 28,000 participants across the United States and compared a risk-based screening plan with standard annual mammography.

Researchers calculated each woman’s risk based on genetics, including sequencing of nine breast cancer genes, and other health factors. Those at the highest risk were advised to alternate between a mammogram and an MRI scan every six months. Elevated-risk participants were instructed to receive an annual mammography plus counseling; average-risk women were told to have mammograms every two years; and low-risk individuals were advised to defer screening until they reached age 50 or their risk increased. The researchers stressed that screening intensity was matched to individual risk, with the goal of potentially reducing unnecessary imaging.

On outcomes, the study found that risk-based screening did not lead to more cancers diagnosed at a late stage (stage 2B or higher) than annual screening, suggesting comparable safety between the two approaches. However, the approach did not reduce the total number of biopsies. Within the risk-based group, higher-risk women underwent more screenings and biopsies and had more cancers detected, while lower-risk women underwent fewer procedures. Researchers said the findings indicate that risk-based screening is a safe alternative to annual screening for women aged 40 to 74, with screening intensity matched to risk.

The study’s authors emphasized that risk-based breast cancer screening is a safe alternative to annual screening for the target age group and that tailoring screening intensity to risk could help avoid unnecessary procedures while maintaining safety.

Fox News medical contributor Dr. Nicole Saphier, associate professor of radiology at Memorial Sloan Kettering Cancer Center in New Jersey, cautioned that while the findings are important, the study does not fully capture what screenings are designed to do—detect cancer early. "If you don’t measure stage 0, stage 1 or stage 2A cancers, you can’t tell whether personalized screening delays diagnosis in a way that matters for survival and treatment intensity," Saphier told Fox News Digital. "Mammography is not without risk — radiation exposure, false positives, anxiety and potential over-diagnosis are real and should be acknowledged. But it remains the most effective, evidence-based tool for detecting breast cancer early, when treatment is most successful."

"Until long-term mortality data support alternative approaches, annual screening beginning at 40 for average-risk women should continue," she added, noting that women should be assessed for breast cancer risk by age 25 to determine if screening should begin earlier. Saphier also argued that labeling women under 50 as "low risk" is outdated given rising diagnoses among younger women.

The study also highlighted that more than 60% of breast cancers in the United States are diagnosed at stage 1 or 2A, where cure rates exceed 90%, underscoring the ongoing importance of early detection when cancer is most treatable.

Despite the findings, experts caution that the trial does not fully evaluate whether risk-based screening changes detection at the earliest and most treatable stages, where screening historically delivers its greatest benefit. The authors said long-term mortality data are needed before any broad changes to standard screening guidelines are adopted. Until then, the study provides important data for discussions about personalized screening strategies within the broader framework of breast cancer prevention and early detection.