For decades, the standard medical advice for women has been clear: begin annual mammogram screenings at the age of 40 to detect breast cancer early. However, a major new study is now challenging this one-size-fits-all approach, suggesting a more personalised strategy could be just as effective.
The WISDOM Trial: A New Approach to Screening
Researchers behind the significant 'WISDOM' trial, which ran from 2016 to 2023 and involved 46,000 American women aged 40 to 74, have proposed a shift in thinking. Instead of relying solely on age and annual exams, they advocate for a comprehensive risk assessment model.
In the trial, over 28,000 participants were randomly assigned to either continue with standard yearly mammograms or to follow a risk-based screening plan. This personalised approach evaluated each woman's individual risk by considering a combination of factors including:
- Genetics
- Breast density (with denser breasts carrying a higher risk)
- Personal and family health history
- Lifestyle factors
Based on this assessment, women were sorted into four distinct risk categories with tailored screening advice. Just over a quarter (25%) in the lowest-risk group were advised to delay screening until age 50. The majority, 62%, deemed at average risk, were told to screen every two years. Meanwhile, 8% with elevated risk were advised to continue annual mammograms, and the highest-risk 2% were instructed to screen twice a year using both a mammogram and an MRI.
Transforming Clinical Practice
The study's findings indicate that this risk-stratified method worked just as well as current yearly screenings in preventing advanced cancers. Notably, it did not reduce the overall number of biopsies required. Lead researcher Dr. Laura Esserman, director of the University of California at San Francisco’s Breast Care Center, believes the results should "transform clinical guidelines for breast cancer screening and alter clinical practice."
"The personalised approach begins with risk assessment, incorporating genetic, biological and lifestyle factors, which can then guide effective prevention strategies," Dr. Esserman explained. She criticised the persistence of outdated methods, telling The New York Times that doctors are "still screening the way we did in the 1980s," despite a 30% drop in breast cancer deaths since mammograms were introduced.
Dr. Esserman also highlighted a key flaw in the current message: "Every time a celebrity has breast cancer, we hear the message that 'screening every year starting at 40 is what’s going to save you.' But it doesn’t necessarily find those who are at highest risk."
The Future of Personalised Prevention
The research team is now advancing their work with a second trial, aiming to refine risk assessment further to better identify women at risk of developing more aggressive forms of breast cancer. For the highest-risk participants in the WISDOM trial, the personalised approach also included contact from a breast health specialist, who provided recommendations on diet, exercise, and potential risk-reducing medications.
Interestingly, when given a choice, women in the study who were not part of the risk-based group overwhelmingly opted for that personalised screening approach over the standard annual plan. This underscores a growing public appetite for healthcare tailored to individual needs. As the debate around optimal screening protocols continues, this study provides compelling evidence that the future of breast cancer prevention may lie in precision medicine rather than a universal timetable.
