Absolute Risk Breast Cancer Screening Strategies Personalized
New BCSC study reveals that analytical modeling study of breast cancer screening, population risk-based screening using 5-year invasive breast cancer risk was associated with similar or greater benefits than age-based screening as well as reduced false-positive recalls.
Five-Year Absolute Risk–Based and Age-Based Breast Cancer Screening in the US
New BCSC study reveals that analytical modeling study of breast cancer screening, population risk-based screening using 5-year invasive breast cancer risk was associated with similar or greater benefits than age-based screening as well as reduced false-positive recalls.
Personalized Breast Cancer Screening: Moving Beyond Just Age
For decades, U.S. breast cancer screening guidelines have largely followed a “one-size-fits-all” approach based primarily on age. While this strategy has likely helped reduce deaths from the disease, a new collaborative study by two CISNET modeling teams and the Breast Cancer Surveillance Consortium suggests that tailoring screening to an individual’s risk factors could save a comparable number of lives (or potentially more), while also reducing common screening downsides, such as unnecessary follow-up tests.
What the research examined
Researchers used simulation modeling to compare traditional age-based screening with 47 personalized screening strategies. These strategies relied on the BCSC risk calculator, which estimates a person’s 5-year risk of developing invasive breast cancer using factors such as race/ethnicity, family history, and breast density.
Key findings: Fewer breast cancer deaths and fewer false alarms
Overall, the study suggests that risk-based screening could improve on the standard approach of mammography every two years between ages 40 and 74. Key takeaways include:
- Saving more lives: At least nine of the personalized strategies prevented similar or more breast cancer deaths than current age-based recommendations.
- Reducing false alarms: One of the biggest drawbacks of frequent screening is a false-positive recall—when a mammogram looks suspicious and leads to a callback for additional imaging or a biopsy, only to find no cancer. The personalized strategies reduced false-positive recalls by 8% to 23%.
- A tailored schedule: One effective approach screened lower-risk individuals every two years, but shifted to annual screening for higher-risk individuals as they aged. Compared with biennial screening for everyone, this strategy saved 6% more lives and produced 13% fewer false-positive recalls.
A paradigm shift in prevention
Risk-based screening represents a shift in early detection: it concentrates more intensive screening on those at higher risk while reducing unnecessary testing for those at lower risk. That could improve breast cancer prevention and reduce the emotional and financial burden associated with false-positive results.
In a related commentary, experts noted that while these findings are promising, moving to risk-based screening raises real-world challenges. Integrating risk assessments into busy primary care workflows will likely require better digital tools and more standardized processes. Most importantly, they emphasized that any new screening model must work equitably across racial and ethnic groups—especially given persistently higher breast cancer mortality among Black women.
Bottom line
Age-based screening guidelines are a useful starting point, but this research adds to the case that personalized screening could become an important part of breast cancer prevention. By tailoring mammogram schedules to an individual’s risk profile, we may be able to maximize the benefits of early detection while minimizing the stress and disruption of unnecessary follow-up procedures.
Alagoz O, Lu Y, Gil Quessep E, Kerlikowske K, Mandelblatt JS, Sprague BL, Trentham-Dietz A, Hampton J, Groeneweg R, de Koning HJ, Miglioretti DL, Schechter CB, van Ravesteyn NT, Tosteson ANA, Stout NK, Lowry KP. Five-Year Absolute Risk-Based and Age-Based Breast Cancer Screening in the US. JAMA Netw Open. 2026 Jan 2;9(1):e2552944. doi: 10.1001/jamanetworkopen.2025.52944. PMID: 41557352; PMCID: PMC12820738. [link]
The full article can be found here
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