Laura J. Esserman; Allison S. Fiscalini; Arash Naeim. JAMA Published online December 12, 2025
Individual breast cancer risk can guide screening initiation, frequency, use of supplemental imaging, and preventive measures to improve breast cancer screening by shifting resources from low-risk women to high-risk women. To determine whether risk-based breast cancer screening is a feasible alternative to annual mammography, a risk assessment tool comprised of The rate of stage IIB cancers was noninferior in the risk-based compared with the annual group. The rate of breast biopsies was not lower in the risk-based group despite fewer mammograms. The cumulative incidence of cancer, biopsy, mammogram, and MRI increased as risk category increased. Risk-based breast cancer screening that includes population-based genetic testing safely stratified risk and screening intensity but did not reduce biopsy rates.sequencing 9 susceptibility genes, polygenic risk score, and the Breast Cancer Surveillance Consortium version 2 model. The risk-based group received 1 of 4 recommendations: (1) highest risk ( 6% 5-year risk, high-penetrance pathogenic variant): alternating mammography and magnetic resonance imaging (MRI) every 6 months and counseling; (2) elevated risk (top 2.5 risk percentile by age): annual mammography and risk-reduction counseling; (3) average risk: biennial mammography; and (4) low risk (aged 40-49 years and
24 Mar, 2026