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Risk-stratified breast cancer screening shows high acceptance of de-escalation in low-risk womenStudy tests personalized breast cancer screening schedules based on risk

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Key Takeaway
Consider risk-stratified screening feasible with high early acceptance, but await final long-term outcomes.

This randomized clinical trial enrolled 1,801 women aged 50-67 years from a routine biennial screening mammography program. The intervention group received a 10-year breast cancer risk assessment using the comprehensive CanRisk model, with automated communication of risk category and suggested screening intervals (low risk: 4 years, intermediate: 2 years, elevated/high: 1 year with additional investigations). The control group received the standard screening program without risk stratification.

Key early results show that acceptance of de-escalated screening was high among low-risk women. After 292 days, only 3.8% (95% CI: 2.3-6.1) had rejected the longer screening interval. Regarding short-term psychological consequences measured at 180 days, life quality showed a 1.6-point reduction in controls (p < 0.0001). Breast cancer worry was reduced in the intervention group compared to controls, with effect sizes of -0.27 for low-risk women (p = 0.007) and -0.33 for intermediate-risk women (p = 0.004).

Safety and tolerability data were not reported in the abstract. A key limitation is that these are interim findings; the authors note that final conclusions await the prespecified 800-day end-of-follow-up. Psychological impact was measured only to 180 days. The study suggests risk-stratified screening is feasible and that automated risk communication has minimal short-term psychological impact, but clinicians should interpret these as preliminary results pending longer-term data.

Researchers conducted a clinical trial to see if a more personalized approach to breast cancer screening is practical and acceptable. They studied over 1,800 women aged 50 to 67 who were due for a routine mammogram. Each woman received a personalized 10-year breast cancer risk score from a computer model. Based on that score, they were given a suggested schedule for their next mammogram, ranging from every 1 to 4 years.

The main goal was to see if women with a low risk score would be comfortable waiting up to 4 years for their next mammogram, instead of the standard 2 years. After about 10 months, only 3.8% of low-risk women had actively rejected the longer wait time, suggesting most were accepting of the idea.

The study also checked if receiving a risk score and a new screening schedule caused short-term anxiety or reduced quality of life. After 6 months, women in the study did not show increased worry about breast cancer. In fact, women in the low and intermediate risk groups reported slightly less worry than women who received standard screening.

It is important to know these are only early results. The study is designed to follow women for a total of about 800 days, so these findings on acceptance and worry are from the first part of the study. The final conclusions about the long-term effects and overall success of this personalized approach are still to come.

What this means for you:
Early trial shows personalized screening schedules may be acceptable, but long-term results are pending.

Study Details

Study typeRct
EvidenceLevel 2
Follow-up804.0 mo
PublishedApr 2026
View Original Abstract ↓
PURPOSE: Risk-stratified screening for breast cancer might improve benefit-to-harm ratio, however, psychological consequences of risk communication and low-risk women's acceptance of de-escalated screening are unclear. PATIENTS AND METHODS: We carried out a randomized clinical trial allocating women aged 50-67 years attending their routine biennial screening mammography 1:1 to a control and intervention group. Women in the control group continued the standard program without risk stratification. Women in the intervention group had their 10-year breast cancer risk assessed using the comprehensive CanRisk model. Around day 90, risk was automatically communicated as low (<2.44%), intermediate (2.44-5.14%), elevated (5.15-<7.99%), and high (≥8.00%) with suggested screening intervals of four years (low), two years (intermediate), one year (elevated) and one year (high risk), and additional investigations for those at elevated and high-risk. RESULTS: Of the 3,949 invited women, 1,801 (46%) were enrolled. Of the intervention group, 49.6%, 38.8%, 8.4% and 3.1% were at low, intermediate, elevated and high risk, respectively. After 292 days, 3.8% (95% confidence interval = 2.3-6.1) of the low-risk women had rejected de-escalated screening. The most significant change of psychological indicators from baseline to day 180 was a 1.6-point reduction of life quality among controls (p < 0.0001), but also reductions of breast cancer worry in the low and intermediate risk groups vs. controls (-0.27, p = 0.007 and -0.33, p = 0.004). CONCLUSION: Risk-stratified breast cancer screening is feasible and de-escalated screening acceptable for low-risk women. Automated risk communication has minimal - if any - impact on short-term psychological well-being. Final conclusions await prespecified 800 days end-of-follow-up.
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