A pioneering study has found that an individualized approach to breast cancer screening that assesses patients’ risk, rather than annual mammograms, can lower the chance of more advanced cancers, while still safely match people to the amount of screening they need.
The results — which come from 46,000 U.S. women enrolled in the first phase of the WISDOM study — support shifting our approach to screening from one that is based on age alone, to one that starts with comprehensive risk assessment to determine each woman’s optimal screening schedule. UCSF was the coordinating center for this study.
“These findings should transform clinical guidelines for breast cancer screening and alter clinical practice,” said Laura J. Esserman, MD, MBA, director of the UCSF Breast Care Center. Esserman is the first author of the study, published Dec. 12 in JAMA and presented at the San Antonio Breast Cancer Symposium. “The personalized approach begins with risk assessment, incorporating genetic, biological, and lifestyle factors, which can then guide effective prevention strategies.”
Breast cancer is the most common cancer in women in the U.S. except for skin cancers. For decades, screening assumed all women have the same risk, and guidelines were based largely on age, despite strong evidence that individual risk varies widely.
WISDOM compared the standard annual mammogram with an approach based on individual risk. Women were stratified into four groups, based on their age, genetics, lifestyle, health history, and breast density, using well validated risk models.
Those in the lowest risk category — 26% of the participants — were told not to screen until they reached age 50 or when an algorithm predicted their risk would meet the level of a 50-year-old. Those with average risk, who made up 62%, were told to screen every two years. Annual screening was recommended for the 8% of women with elevated risk. The 2% of women in the highest risk category received two screenings a year, alternating between mammography and MRI, regardless of their age.
Those with either elevated or highest risk got personalized recommendations for how to reduce their risk of getting breast cancer. This included an online tool to make breast health decisions and direct outreach from a breast health specialist. The recommendations included ways to improve diet and exercise, as well as considerations for risk-reducing medications.
This risk-based screening approach did not result in an increase in the frequency of higher stage cancers. Participants who did not want to be randomized could still enroll in an observational group, where they could choose their own screening approach. Of these participants, 89% chose risk-based screening, showing that it was preferred by women.