Dr Esserman on the Potential Role for Risk-Based Breast Cancer Screening

This is just the beginning of how we can make [breast cancer] screening and prevention work for everybody.

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 the potential role for risk-based breast cancer screening in real-world practice on the heels of results from the WISDOM 1.0 breast cancer screening trial (NCT02620852).

At the 2025 San Antonio Breast Cancer Symposium, Esserman and colleagues presented findings from WISDOM 1.0, which evaluated a risk-based screening schedule vs traditional annual screening in female participants. Data showed that risk-based screening was safe and was not associated with an increased incidence of stage IIB or higher breast cancers vs standard annual screening.

Esserman began by emphasizing the collaboration required to implement this approach at scale, explaining that conducting WISDOM 1.0 involved geneticists, genetic counselors, primary care physicians, and OB-GYN specialists, as well as investigators working on risk-prediction modeling. She noted that the program had been structured as a nationwide effort in which any woman could participate, reflecting a broader goal of expanding access to individualized risk assessment.

Esserman said the ideal long-term solution would be the creation of a population-based screening program in the United States, similar to those already implemented in parts of Europe and Australia. She noted that establishing this infrastructure could serve as the foundation for integrating genetic testing, risk modeling, and prevention strategies into routine care. In the absence of a national program, Esserman stated that the initiative had relied on partnerships to help scale the effort and reach larger patient populations.

She emphasized that genetic testing alone was insufficient, noting that risk information needed to be interpreted within a broader clinical context. Although work remains, findings for risk-based screening readout thus far represent an early but important step toward making personalized breast cancer prevention accessible on a broader scale, she concluded.