Overview
- The randomized WISDOM trial compared a personalized, risk-stratified strategy with routine annual mammography for women aged 40 to 74.
- Risk-based screening did not increase diagnoses of advanced disease (stage 2B or higher) compared with annual screening.
- Stratification used genetics, family history, breast density and clinical factors, directing MRI plus mammography every six months for the highest risk, biennial mammograms for average risk and delayed screening until 50 for the lowest risk.
- The approach did not lower overall biopsy rates, though higher-risk participants underwent more imaging and procedures and lower-risk participants had fewer.
- Coverage notes differing enrollment figures, with more than 28,000 women randomized within a larger cohort, and some clinicians caution against changing guidelines until impacts on early-stage detection and mortality are shown.