#396 ‒ Breast cancer screening: understanding risk, deciding when to start and how often to screen, and choosing the right imaging strategy

Breast cancer screening effectiveness hinges on personalizing strategies based on individual risk rather than relying solely on population-level guidelines. While mammography remains the foundational tool, particularly digital breast tomosynthesis, it often falls short for women with dense breast tissue or high-risk profiles. Formal risk assessment by age 25 is essential to determine the necessity of supplemental imaging like MRI, which significantly improves detection for high-risk individuals. Although biennial screening is often cited for population efficiency, annual mammography provides superior mortality reduction for the individual. Addressing the gap between current screening practices and optimal protocols—including the underutilization of MRI and the failure to account for specific risk factors—is critical to reducing the 42,000 annual breast cancer deaths in the United States.