Dr Esserman on Results of the WISDOM 1.0 Breast Cancer Screening Study

What we saw was that risk-based screening did not increase the risk of finding stage IIB cancers in any of the groups. It appropriately stratified risk: the highest-risk [people] had the highest number of cancers, and the lowest-risk people had the lowest number of cancers.”

Laura J. Esserman, MD, MBA, the Alfred A. de Lorimier Endowed Chair in General Surgery, a professor Departments of Surgery and Radiology, and affiliate faculty in the Institute for Health Policy Studies at the University of California San Francisco (UCSF), as well as director of the UCSF Breast Care Center and co-leader of the Breast Oncology Program at the UCSF Helen Diller Family Comprehensive Cancer Center, discussed key results from the WISDOM 1.0 breast cancer screening trial (NCT02620852).

The study evaluated a risk-based screening schedule vs traditional annual screening in female patients 30 to 74 years of age; the study initially included patients 40 to 74 years of age before the trial protocol was amended to expand the age range. Findings presented at the 2025 San Antonio Breast Cancer Symposium showed that the risk-based screening method was safe, with no increased incidence of stage IIB or higher breast cancers compared with traditional annual screening. Esserman explained that the risk-based strategy translated to the highest incidence of cancer being reported in the highest-risk patients, with rates dropping in concordance with risk level. Additionally, no stage IIB or higher tumors were reported in the highest-risk group among patients who underwent risk-based screening, she explained.

Esserman explained that the implementation of traditional screening has led to an increase in early-stage tumors without a corresponding drop in later-stage tumors. With risk-based screening, this trend was not observed, she said.

Notably, Esserman said that the protocol for randomly assigning patients also revealed important information. In the study, participants were allowed to elect for random assignment, or they could opt to choose their screening method to be included in a separate observational cohort. Of the 46,403 participants enrolled, most (n = 28,372) elected to be randomly assigned. Within the observational cohort (n = 18,031), the vast majority of patients (n = 15,980) picked risk-based screening over annual screening (n = 2051). These assignment and selection trends underscore the general controversy of current screening methods and patients’ desires to receive personalized approaches vs one-size-fits-all methods, Esserman explained.