The WISDOM Trial and the Evidence Base for Risk-based Breast Cancer Screening

Breast cancer screening recommendations continue to rely largely on age, despite substantial variation in individual risk.Advances in risk prediction, including the incorporation of breast density, polygenic risk scores (PRS), and germline susceptibility variants, have renewed interest in screening strategies that adapt screening intensity according to individual risk rather than age alone.However, evidence supporting risk-based screening has largely been derived from observational studies and simulation models.In this issue, Esserman and colleagues report the results of the Women Informed to Screen Depending on Measures of Risk (WISDOM) randomized clinical trial, providing the first large-scale randomized evaluation of a comprehensive risk-based screening strategy.