New study questions whether annual mammograms are necessary for most women

A large U.S. trial published in the Journal of the American Medical Association found that a risk-based approach to breast cancer screening may be as safe as standard annual mammography for women aged 40 to 74. The WISDOM randomized clinical trial enrolled more than 28,000 women across the United States and compared a risk-based screening schedule, tailored to each participant’s risk, with the conventional practice of yearly mammograms. Researchers calculated each woman’s risk using genetics—sequencing nine breast cancer–related genes—and other health factors, then assigned them to either the risk-based pathway or annual screening.

Participants in the risk-based group were categorized by risk level and given corresponding screening plans. Those at the highest risk were advised to alternating between a mammogram and an MRI every six months. Elevated-risk women were told to undergo annual mammography accompanied by counseling. Average-risk participants were scheduled to have mammograms every two years, while those deemed low risk were advised to forego screening until they reached a higher risk profile or turned 50.

The researchers found that risk-based screening did not result in more advanced cancers diagnosed (defined as stage 2B or higher) compared with annual screening, suggesting that the risk-based approach can be as safe as conventional methods in delaying progression to more serious disease. However, the study also showed that risk-based screening did not reduce the total number of biopsies. Among women in the risk-based group, those at higher risk underwent more screening procedures, biopsies and cancer detections, while those at lower risk experienced fewer procedures.

“[The] findings suggest that risk-based breast cancer screening is a safe alternative to annual screening for women aged 40 to 74 years,” the researchers wrote in the study summary. “Screening intensity matched individual risk, potentially reducing unnecessary imaging.” The publication of the study has spurred commentary from clinicians who caution that the trial focuses on screening safety and cancer detection patterns, not yet on long-term outcomes such as mortality.

Dr. Nicole Saphier, a Fox News medical contributor and associate professor of radiology at Memorial Sloan Kettering Cancer Center, offered context on the findings. She told Fox News Digital that while the results are important, they do not address the fundamental purpose of screening: to 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 said. “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.”

Saphier added that labeling women under 50 as “low risk” is outdated, noting rising breast cancer diagnoses among younger women. She argued that risk should be assessed earlier in life to determine whether screening should begin before age 40 in certain cases. “Until long-term mortality data support alternative approaches, annual screening beginning at 40 for average-risk women should continue,” she said. She also suggested that risk assessment could begin by age 25 to determine whether earlier screening is warranted.

The study’s authors acknowledged that while the risk-based model may tailor imaging to risk, it does not yet provide a complete assessment of early-detection benefits across all cancer stages. A substantial share of U.S. breast cancers are diagnosed at earlier stages—about 60% are stage 1 or 2A, a group with cure rates above 90% if treated promptly—yet the trial did not fully evaluate whether risk-based screening changes detection at those earlier, highly treatable stages. Still, the researchers characterized the risk-based approach as a safe option that could reduce unnecessary imaging for many women, pending longer follow-up data on outcomes such as mortality.

The WISDOM trial represents one of the most ambitious efforts to personalize breast cancer screening by risk, reflecting a broader shift in medicine toward tailoring preventive care to individual biology and risk. While experts stress that more data are needed to determine the long-term impact on survival and on the balance of benefits and harms, the study provides a framework for conversations between patients and clinicians about screening choices and risk management. The findings may influence future guidelines, especially for women who fall into high- or low-risk categories based on genetic and health-profile factors, and could lead to more nuanced recommendations about how often people should be screened and with which modalities.

As researchers continue to monitor long-term outcomes, many clinics may begin to integrate risk-based discussions into shared decision-making, recognizing that screening is a balance between benefit, risk, and patient preference. Additional studies are expected to refine how best to combine genetic results with clinical and lifestyle information to optimize screening strategies for diverse populations.