Breast screening has traditionally followed a "one-size-fits-all" approach. In Australia, programs such as BreastScreen Australia offer regular mammograms to women within a certain age group, annually or biennially according to risk.
Whilst we have seen significant improvement in mortality and morbidity related to breast cancer since the inception of the national BreastScreen program, emerging research supports a deeper risk stratified approach — both for women at population risk and increased risk. This research is further strengthened by studies demonstrating the benefit of newer imaging techniques such as contrast-enhanced mammography and MRI in high risk populations.
Moving beyond one-size-fits-all
Breast cancer risk varies significantly between individuals. Factors such as family history, genetic mutations, breast density, and lifestyle all play a role.
Despite this, most screening programs are based primarily on age.
This means:
- Some women at higher risk may not receive sufficient screening
- Others at lower risk may undergo more imaging than necessary
Increasingly, research is showing that a more personalised approach — known as risk-based screening — may offer a better way forward.
What is risk-based screening?
Risk-based screening tailors both the type and frequency of imaging to an individual's level of risk.
Rather than applying the same schedule to everyone, screening may be adjusted so that:
- Higher-risk women receive more intensive screening, often including contrast enhanced imaging such as contrast-enhanced mammography or MRI
- Lower-risk women may require less frequent imaging
This approach aims to detect cancers early while also reducing unnecessary investigations.
What does the evidence show?
Large international studies are now supporting this shift.
The landmark WISDOM Study, led by Laura J. Esserman, compared traditional annual screening with a personalised, risk-based approach.
The findings showed that:
- Risk-based screening was as safe as annual screening
- Screening could be tailored without compromising cancer detection
- Higher-risk women benefited from more targeted imaging strategies
This represents an important step toward more precise and efficient breast cancer screening.
Why breast density matters
One of the key factors in risk-based screening is breast density.
Dense breast tissue:
- Is associated with an increased risk of breast cancer
- Can make cancers more difficult to detect on mammography
For women with dense breasts, additional imaging such as:
- Ultrasound
- MRI
- Contrast Enhanced Mammography (CEM)
may improve cancer detection.
This is one of the reasons why a uniform screening approach may not be sufficient for all patients.
The role of modern risk tools
Validated tools such as iPrevent can estimate an individual's risk of developing breast cancer by incorporating multiple factors, including:
- Age
- Family history
- Breast density
- Reproductive history
- Genetic information (where available)
These tools are increasingly used to guide more personalised screening strategies.
Importantly, they are not designed to replace clinical care, but to support informed discussions between patients and their doctors.
What does this mean for you?
For many women, standard screening through BreastScreen Australia remains appropriate and effective.
However, for others, particularly those with:
- Dense breast tissue
- A family history of breast cancer
- Other risk factors
a more tailored approach to screening may be beneficial.
A more personalised approach
At Canberra Breast, we support a risk-based approach to breast imaging.
This means:
- Considering each patient's individual risk profile
- Selecting the most appropriate imaging modality
- Ensuring timely and accurate diagnosis
As research continues to evolve, breast screening is moving toward a more personalised, evidence-based model — one that recognises that the right screening is not the same for everyone.
Final thoughts
The future of breast screening is not about doing more imaging or less imaging. It is about doing the right imaging for the right patient at the right time.
References
- Esserman LJ, et al. Comparison of Risk-Based vs Annual Breast Cancer Screening. JAMA. 2025. — Landmark trial demonstrating that personalised, risk-based screening is as safe as annual screening.
- Bakker MF, et al. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. New England Journal of Medicine. 2019. — MRI significantly reduces interval cancers in women with dense breasts.
- Shieh Y, et al. Breast Cancer Screening in the Precision Medicine Era: Risk-Based Screening. JNCI. 2017. — Foundational paper outlining integration of risk factors, genetics, and density.
- iPrevent — Developed by the Peter MacCallum Cancer Centre. Validated Australian tool for estimating individual breast cancer risk.
- BreastScreen Australia — Australian Government Department of Health. National population-based screening program.
- Mavaddat N, et al. Polygenic Risk Scores for Prediction of Breast Cancer Risk. Nature Genetics. 2019. — Demonstrates improved risk stratification using genetic profiling.