Dr Esserman on the Need to Improve Screening Strategies in Breast Cancer

We don’t treat every [patient with breast cancer] the same, so it doesn't make sense for us to screen every person the same.

Laura J. Esserman, MD, MBA, the Alfred A. de Lorimier Endowed Chair in General Surgery, a professor in the 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, detailed the need for improved screening methods and strategies for patients with breast cancer.

At the 2025 San Antonio Breast Cancer Symposium, Esserman and colleagues presented findings from the WISDOM 1.0 trial (NCT02620852), which is evaluating a risk-based cancer screening schedule vs traditional annual screening. Results reported at the meeting showed that the risk-based method was safe, and there were no increases in the rate of stage IIB or higher cancers with the use of risk-based screening. Notably, among patients in the risk-based cohort, no instances of stage IIB or higher cancer were reported in patients deemed the highest risk.

When designing the WISDOM 1.0 trial, Esserman and colleagues aimed to investigate a screening strategy that better accounts for the varying risk levels of developing breast cancer and the heterogeneity of the disease, she explained. As such, WISDOM 1.0 aimed to show that risk-based screening was safe without leading to an increase of stage IIB or higher disease.

Esserman also noted that current breast cancer screening strategies are often criticized because although these methods have led to an increase in the detection of early-stage cancers, there has not been a concordant drop in the detection of higher-stage tumors. This has led to worries about over-screening and increasing the burden on those requiring screening, she added. Esserman said that the continued detection of higher-stage tumors with standard screening methods points to a gap in current protocols. Improved methods could help identify people at the highest risk for cancer and integrate strategies that would allow for earlier detection, she concluded.