Risk-based breast screening personalizes detection by using genetic information, family history, breast density, and lifestyle factors to identify women at elevated risk early while reducing unnecessary screening for lower-risk women, though implementing these strategies into clinical practice remains challenging.
- The Danish PRSONAL trial showed women at low risk accepted mammography every four years instead of two years, with only 3.8% rejecting the recommendation.
- Multifactorial risk assessment identified up to 34.8% of women under 50 who developed breast cancer, compared to just 4.4% using conventional family history alone.
- Approximately 79% of incident breast cancers occurred in women below the 20% lifetime-risk threshold used for supplemental MRI eligibility, indicating current criteria may miss high-risk cases.
- The Netherlands plans to introduce supplemental MRI screening for women with extremely dense breasts starting in 2030, with modeling suggesting it could prevent around 110 additional breast cancer deaths annually.
- Clinicians currently lack established guidelines for integrating conflicting risk estimates from lifetime-risk models and short-term AI imaging scores into screening decisions.
One of the most pressing questions in breast cancer screening is how to identify women at increased risk early enough to offer effective prevention and detection, while sparing those at lower risk unnecessary examinations.
With treatment outcomes strongly influenced by the stage at diagnosis, and an expanding understanding of genetic susceptibility, breast density, and hormonal and lifestyle factors, researchers have more information than ever to guide screening decisions.
At the European Society of Breast Imaging (EUSOBI) 2026 congress in Maastricht, experts examined how this knowledge could translate into more personalized screening, from identifying younger women at elevated risk to reducing screening frequency for those at lower risk.
From left: Nicolien T. van Ravesteyn, PhD, Dr. Antonis Antoniou, and Dr. Stamatia Destounis.EUSOBI 2026
Less screening for women at lower risk?
In the Danish PRSONAL trial, women classified as low risk were offered mammography every four years instead of every two years. After approximately 10 months, only 3.8% had rejected the recommendation. Longer-term adherence and clinical outcomes remain to be established.
Another study involving women younger than 50 found that conventional family-history-based criteria identified only 4.4% of those who subsequently developed breast cancer over 10 years. Multifactorial assessment identified up to 34.8%, although the proportion meeting referral criteria increased from 1.4% to 26.5%.
Dr. Antonis Antoniou of the University of Cambridge in Cambridge, U.K., presented the findings and discussed CanRisk, a model combining genetic information, family history, breast density, and hormonal and lifestyle factors to estimate individual cancer risk.
When risk estimates disagree
Dr. Stamatia Destounis of Elizabeth Wende Breast Care in Rochester, New York, U.S., presented data from nearly 94,000 screening patients. Approximately 79% of incident breast cancers occurred among women below the conventional 20% lifetime-risk threshold commonly used to determine eligibility for supplemental MRI. Among women classified as high risk, only about one in five underwent the examination.
The growing use of artificial intelligence (AI) raises further questions. Mammography-based AI models can estimate cancer risk over the next few years, while multifactorial models incorporate clinical and genetic information to assess longer-term susceptibility. A woman may therefore have a low lifetime-risk estimate but a high short-term imaging-based score.
How should clinicians act on such conflicting results, asked Dr. Fiona Gilbert of the University of Cambridge during the panel discussion. The speakers acknowledged that no established approach exists for integrating the different estimates into routine screening decisions.
Dutch MRI rollout planned for 2030
Nicolien van Ravesteyn, PhD, of Erasmus University Medical Center in Rotterdam, Netherlands, presented modeling suggesting that supplemental MRI for women with extremely dense breasts could be cost-effective.
In one scenario, biennial MRI screening was estimated to require approximately 45,000 examinations annually in the Netherlands and prevent around 110 additional breast cancer deaths per year. More frequent imaging, however, also meant more false-positive findings, overdiagnosis, and higher costs.
The Netherlands is preparing to introduce supplemental MRI screening for women with extremely dense breasts from 2030, with implementation planned in phases.
For the wider adoption of risk-based screening, Antoniou emphasized the need for further implementation studies and better integration of the available risk information into clinical practice.
