Technologists will be key in personalized breast cancer screening, though much work is needed before deviating from standardized screening, according to a presentation given March 6 at ECR 2026.
In her talk, Patsy Whelehan, PhD, from Great Western Hospital in Swindon, England, discussed risk-based breast cancer screening from the mammography technologist’s (mammographer’s) perspective.
“It is essential to have sufficient robust evidence that any increased screening intensity will do more good than harm and be cost-effective," Whelehan said.
Debate continues about risk-based versus standard age-based or population-based breast cancer screening. Two recent studies found that risk-based screening is on par with conventional mammography screening. However, medical imaging societies have criticized the methodologies these studies employed.
But that hasn’t quelled talks about risk-based screening’s potential in providing more personalized patient care.
Whelehan discussed how mammography technologists can adapt imaging techniques to individual patient risk profiles. She also outlined challenges and opportunities for implementing personalized screening into practice.
What the research says
Prior research suggests that population-based screening is “relatively inexpensive,” quick, and simple. But standard mammography achieves only moderate sensitivity and struggles with imaging dense breasts, leading to potential interval cancers. Results from the Mammography Screening with Artificial Intelligence (MASAI) trial, published in 2026, found that mammography has an average sensitivity of about 74%, while specificity is 98.5%, with AI increasing sensitivity to over 80%.
Proponents of risk-based screening also say this approach can address overdiagnosis concerns. A 2024 report that Whelehan cited suggested that 2.6 cancers per 1,000 women are overdiagnosed with regular screening.
“[What] we must do with any intensification of screening is not intensify the harms along with the benefits,” Whelehan noted.
She said the fundamental first step toward effective risk-based screening is meaningful risk assessment, taking account of several factors, such as family history, genetic testing, breast density, and new deep learning-based features from mammography images, among others.
Whelehan also discussed results from the Women Informed to Screen Depending on Measures of Risk (WISDOM) trial, the Predicting Risk of Cancer at Screening 2 (PROCAS-2) trial, and the My Personal Breast Screening (MyPEBS) trial, which showed potential benefits for women’s knowledge of their risk and screening as well as noninferiority compared with standard screening.
Supplemental imaging’s role
She also discussed the role of supplemental screening, including contrast-enhanced mammography (CEM), MRI, automated whole-breast ultrasound, and handheld ultrasound. Studies have examined the utility of these modalities for imaging dense breasts in addition to mammography.
“It does look as if the contrast-based protocols are likely to be the front-runners if there should be widespread implementation of supplemental screening in dense breasts,” Whelehan said. “Abbreviated MR is obviously more appealing because of the lower resource intensity.”
She also cited results from the BRAID trial, which showed that women “slightly” prefer CEM over MRI.
Finally, Whelehan highlighted staffing challenges for risk-based screening. She cited a survey published in 2025 showing that the largest barriers to supplemental screening include funding and cost, lack of trained radiologists and technologists, lack of sufficient equipment, and the potential for recall rates burdening already-overstretched health systems.
Future outlooks
Whelehan gave some predictions in her presentation, reiterating that good evidence is needed before implementing risk-based screening. She also highlighted the challenge of adjusting from standardized screening to risk-based screening.
“I’m skeptical that multifaceted risk assessment … is going to be the way forward,” she said. “I’m quite hopeful about the deep learning methods based on images, but it’s early days, and the concerns about the validity of the studies so far have been highlighted already.”
Whelehan noted that the finding about women being more informed of their risk is a “teachable moment” in talking about prevention and lifestyle.
Finally, she highlighted the key role of mammography technologists in risk assessment. This includes providing sufficient capacity for supplemental screening and understanding how risk-based screening works to better communicate with patients.
Our full coverage of ECR 2026 can be found here.
