A new study from the University of California, San Francisco suggests a major shift in how women approach breast cancer screenings. Published in JAMA, the findings indicate that personalized screening-based on individual risk factors like genetics, lifestyle, and family history-might potentially be more effective than the current standard of annual mammograms for all women. The research, stemming from the ongoing WISDOM study involving nearly 46,000 participants, offers a potential path toward earlier detection and fewer needless tests, marking a important step toward precision medicine in women’s health.
Personalized breast cancer screening may improve detection and reduce unnecessary tests. A large-scale study in the United States suggests that assessing individual risk could change how women are screened for breast cancer.
New data suggests that tailoring breast cancer screening to a woman’s individual risk level could lead to more effective detection of the disease and avoid unnecessary testing. This approach represents a shift from a one-size-fits-all strategy based solely on age, and instead focuses on acknowledging the varying levels of risk among individuals. Early detection is crucial for improving outcomes in breast cancer, making this research particularly significant for women’s health.
A groundbreaking study conducted in the United States shows that personalized breast cancer screening, based on individual risk, is more effective than annual mammograms for all women. This strategy reduces the likelihood of detecting cancer at later stages while ensuring appropriate levels of investigation for each person.
The results are based on data from approximately 46,000 women participating in the first phase of the WISDOM (Women Informed to Screen Depending on Measures of Risk) study, a project coordinated by the University of California, San Francisco (UCSF). The analysis indicates a need to move away from screening guidelines almost exclusively based on age, toward a model that begins with a detailed assessment of individual risk.
Published in December in the journal JAMA and presented at the San Antonio Breast Cancer Symposium, the study reveals that the risk of breast cancer varies considerably from person to person, challenging long-held assumptions underlying current screening recommendations. Researchers emphasized that the risk assessment included genetic, biological, and lifestyle factors.
Within the WISDOM study, participants were divided into four risk categories using validated models that considered age, genetic profile, lifestyle, medical history, and breast density.
Approximately 26% of women, categorized as low risk, were advised to delay screening until age 50 or until the risk algorithm indicated an equivalent risk to a 50-year-old woman.
Those with moderate risk, representing 62% of participants, were recommended to undergo screening every two years. Annual screening was recommended for 8% of women considered to be at high risk, and the 2% in the highest risk category were screened twice a year, alternating between mammography and magnetic resonance imaging (MRI), regardless of age.
Women in the high and very high-risk categories also received personalized recommendations for reducing their breast cancer risk. These included access to an online breast health decision-making tool and direct counseling from a specialist. Recommendations focused on dietary and physical activity modifications, as well as consideration of risk-reducing medication where appropriate.
The risk-based approach did not lead to an increase in the number of cancers diagnosed at advanced stages. Furthermore, women who did not want to be automatically assigned to one of the screening strategies could participate in an observational group where they chose their own screening method. Of these women, 89% opted for risk-based screening, indicating a clear preference for this strategy.
Another important finding of the study related to genetic testing. Researchers found that 30% of women with genetic variants associated with increased breast cancer risk did not report a family history of the disease. According to current clinical guidelines, these individuals would not typically be eligible for genetic testing.
Beyond well-known variants like BRCA1 and BRCA2, the study also analyzed other genetic changes. When combined into a polygenic risk score, these changes can improve the estimation of breast cancer probability. Integrating this data led to the reclassification of approximately 12–14% of participants into a different risk category.
The WISDOM study, initiated in 2016, has included over 80,000 women to date. In recent years, researchers have begun recruiting participants over the age of 30 to identify those at risk of developing aggressive forms of breast cancer associated with certain genetic variants.
Research continues through WISDOM 2.0, which aims to refine risk assessment and provide personalized screening and prevention options, with the goal of improving the safety and effectiveness of breast cancer screening strategies.
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