Study sparks debate over annual breast cancer screening

Oncology and radiology leaders have called into question a study led by researchers at Oakland-based University of California that found personalized risk-based breast cancer screening as effective as standard annual screening guidelines. The study, published Dec. 12 in JAMA Network, sees risk-based screening as an “opportunity to modernize screening in the precision medicine era.”

In a Dec. 12 statement released after the study’s publication, the American College of Radiology said “the study design and results do not provide adequate information to support changes to present screening policies.” Leaders specializing in breast imaging and cancer care shared their reactions to in a Dec. 15 report in The Washington Post:

Here are five things to know from the study and the response:

1. The study enrolled 28,372 women ages 40-74 between September 2016 and February 2023, with follow-up through Sept. 5, 2025, who did not have a prior diagnosis of breast cancer.
   
   Participants were enrolled from all 50 U.S. states and the final study cohort was 77% non-Hispanic white.
   
   
2. The main objective of the study was to see if “risk-based breast cancer screening is a feasible alternative to annual mammography,” the study authors wrote.
   
   Participants were randomized into two groups, a risk-based and an annual mammography group.
   
   The risk-based group received personalized recommendations based on individual risk level. Recommendations ranged from imaging and counseling every six months, to delayed screening until risk increased or they reached age 50.
   
   
3. According to the study’s findings, the rate of cancers identified at or above stage 2 was “noninferior” among women who received risk-based screening compared to women in the annual screening group.
   
   Despite fewer mammograms, the breast biopsy rate was not lower in the risk-based group. 
   

4. The American College of Radiology identified several concerns with the study design and findings, including:
   
   
   • “Substantial” nonadherence and low adherence to screening among participants in both groups.
     
     
   • The small number of cancers found during the study was “likely not” representative of the U.S. population.
     
     
   • By recording cancers only in stage 2 or higher, the study identified only cancers that were “likely already present on clinical breast exams or self-breast exams.”
     
     
   • The model would require “intense breast health specialist intervention” that may not be replicable in clinical settings, according to the ACR.
     
     
5. Oncology leaders shared their insights on the study’s findings with the Post:
   
   
   • Steven Isakoff, MD, PhD, co-clinical director of breast oncology at Boston-based Mass General Brigham Cancer Institute, said the study results were a “positive first step” but noted the demographics of the study participants represented more white, college-educated women compared to the general U.S. population.
     
     
   • Vivian Jolley Bea, MD, director of the breast program at New York Presbyterian-Brooklyn Methodist Hospital and faculty at NewYork-Presbyterian Weill Cornell Medical Center, both in New York City, noted the lack of diversity in the study as well.
     
     “It’s not just family history. It’s not just breast density. It’s tumor biology, and so if we’re not including [Black women] in a randomized clinical trial that can then inform how we screen people moving forward, then we’re doing a disservice,” she said.
     
     
   • Debra Monticciolo, MD, section chief of breast imaging at Dartmouth Hitchcock Medical Center in Lebanon, N.H., called the study’s plan for more personalized screening “laudable” but hard to put into practice. She also noted the low-adherence to mammogram screening among both high- and low-risk study participants.
     
     For guidelines to change, “you’d want to show it’s a better approach, not just a non-inferior approach,” Dr. Monticciolo told the Post. “It’s hard to tell from this data that it is.”

Read the full study here.