SABCS: Risk-Based Screening Noninferior for Identifying Stage ≥IIB Breast Cancer

WEDNESDAY, Dec. 17, 2025 (HealthDay News) -- Risk-based screening, including genetic testing, is noninferior to annual screening for detecting stage ≥IIB cancers and does not reduce biopsy rates despite fewer mammograms, according to a study published online Dec. 12 in the Journal of the American Medical Association to coincide with the annual San Antonio Breast Cancer Symposium, held from Dec. 9 to 12 in San Antonio.Laura J. Esserman, M.D., from the University of California in San Francisco, and colleagues conducted a parallel-group, randomized clinical trial comparing risk-based to annual breast cancer screening (14,212 and 14,160 women, respectively, aged 40 to 74 years). The risk assessment included sequencing of nine susceptibility genes, polygenic risk score, and the Breast Cancer Surveillance Consortium version 2 model; based on risk, the group received four recommendations: alternating mammography and magnetic resonance imaging (MRI) every six months plus counseling (highest risk); annual mammography and risk-reduction counseling (elevated risk); biennial mammography (average risk); and no screening until risk is 1.3 percent or greater or age 50 years (low risk).The researchers found that the rate of stage ≥IIB cancers was noninferior in the risk-based versus the annual group (30.0 versus 48.0 per 100,000 person-years). The risk-based group did not have a lower rate of breast biopsies (rate difference, 98.7 per 100,000 person-years), despite having fewer mammograms (rate difference, −3,835.9). As risk category increased, the cumulative incidence of cancer, biopsy, mammogram, and MRI increased."These findings should transform clinical guidelines for breast cancer screening and alter clinical practice," Esserman said in a statement. "The personalized approach begins with risk assessment, incorporating genetic, biological, and lifestyle factors, which can then guide effective prevention strategies."In a statement, the American College of Radiology thanked the researchers "for attempting to determine whether risk-based breast cancer screening is a feasible alternative to annual mammography as the health care community works toward optimal breast cancer screening approaches. However, the study design and results do not provide adequate information to support changes to present screening policies."One author disclosed ties to the pharmaceutical industry.Abstract/Full TextMore Information.Sign up for our weekly HealthDay newsletter