Study Finds Risk-Based Breast Cancer Screening May Improve Outcomes Over Age-Based Approach

A newly published study suggests that tailoring breast cancer screening strategies to a woman's individual risk level—rather than relying solely on age—could lead to improved detection rates and fewer false positives.

The research, published this week in JAMA Network Open, compares five-year detection outcomes between traditional age-based screening guidelines and various risk-based approaches. The findings indicate that risk-based screening not only prevents more cancer deaths but also reduces the number of unnecessary follow-up procedures.

“By targeting women outside the highest-risk groups—such as breast cancer survivors or those with genetic variants or prior radiation exposure—risk-based screening could improve effectiveness while minimizing harms,” said lead author Oguzhan Alagoz, PhD, of the University of Wisconsin-Madison’s Department of Industrial and Systems Engineering.

To conduct their analysis, the research team used two established models from the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET). These models simulated breast cancer outcomes in U.S. women aged 40 and older with no prior history of the disease. Researchers compared various screening strategies—some based on age and others based on calculated five-year breast cancer risk—against a no-screening baseline.

The results revealed that nine risk-based strategies produced detection rates comparable to or better than those seen with standard biennial mammograms for women aged 40 to 74. Some strategies using personalized risk thresholds resulted in up to 6% more averted breast cancer deaths. Additionally, risk-based screening was associated with 13% fewer false positives compared to traditional methods.

The authors argue that these findings support a shift toward more personalized screening models that account for evolving individual risk factors over time, rather than treating all women in a given age group the same.

“By offering more intensive screening to women at high risk and less frequent screening to those at low risk, these strategies may maintain or enhance screening benefits while lowering unnecessary procedures, costs, and anxiety,” the researchers noted.

They also emphasized that a personalized approach could be particularly impactful in avoiding overdiagnosis and overtreatment for women unlikely to develop aggressive cancers, while ensuring timely detection in those at higher risk.

The study adds to a growing body of evidence calling for updates to current breast cancer screening guidelines to reflect a more individualized approach. However, the researchers acknowledged that further work is needed to validate risk-based screening in clinical settings and determine how best to implement such models in practice.

Overall, the findings suggest that risk-based breast cancer screening strategies could offer a more effective and patient-centered alternative to one-size-fits-all guidelines, with the potential to improve outcomes while reducing harms.