We now know that breast cancer is a collection of biologically distinct subtypes, each with different patterns of growth and risk. We also know that family history, breast density, reproductive factors, lifestyle, and genetics all contribute towards the risk for breast cancer.
Seen through this lens, the traditional age-based model is an over-simplification of a complex disease with diverse pathways and outcomes.
Shift towards risk-adapted screening
Risk-adapted screening moves away from age-based rules and tailors screening to a woman’s individual risk. Factors such as family history, breast density, reproductive history and genetics are used to decide who needs closer surveillance and who can safely screen less often.
On December 12, 2025, the first results of the WISDOM trial (Women Informed to Screen Depending on Measures of Risk) were published in the Journal of the American Medical Association (JAMA). This landmark US randomised study compared annual mammography — the traditional age-based approach — with personalised, risk-adapted screening in women aged 40-74, using individual risk factors for breast cancer such as breast density, family history and genetic risk.
The findings were encouraging. Risk-based screening was shown to be feasible, acceptable to women, and clinically sound, with comparable detection of advanced cancers. In short, tailoring screening to individual risk did not compromise safety — and may allow health systems to use resources more efficiently.
Upcoming data from European studies such as My Personalised Breast Screening (MyPeBS) will further inform how this approach can be implemented at scale.
Why this matters for India
India has never had a national, population-based mammography programme. What exists today is opportunistic screening and scattered private initiatives. This absence is often described as a failure, but what if this “failure” is also India’s biggest opportunity?
Unlike Western countries, where breast cancer is predominantly a post-menopausal disease, the median age at diagnosis in India is just 47 years, nearly a decade younger, reducing mammography’s sensitivity and increasing the risk of missed cancers. Data from the National Family Health Survey (NFHS-5) and Longitudinal Ageing Study in India (LASI Wave 1) show that barely 0.9 per cent of women have ever had a clinical breast examination, and just 1.3 per cent of women aged 45 years and above have undergone a mammogram.
Recognising these constraints, the WHO’s Global Breast Cancer Initiative (GBCI) recommends that low- and middle-income countries prioritise early-diagnosis pathways and adopt targeted, risk-based screening, not blanket population programmes.
Taken together, India’s “missed opportunity” could, in fact, be a clean slate.
What leapfrogging could look like
Instead of retrofitting a 40-year-old system to suit our realities, India has the rare chance to design one from scratch — a risk-adapted model that matches our demographics and leverages our health-system strengths.
Many of the building blocks already exist. A vast community-health workforce of (Accredited Social Health Activist) ASHAs, Auxiliary Nurse Midwives (ANMs), and primary-care nurses routinely delivers maternal and preventive care, making breast-health risk assessment a natural addition. The Ayushman Bharat Digital Mission, launched in 2021, can support tracking of screening, referrals, and follow-up. The Genome India Project offers a long-term opportunity to develop breast-cancer risk models grounded in Indian genetic data, rather than imported assumptions. The National Cancer Grid provides a backbone for quality standards, referral pathways, and clinical oversight, ensuring early detection is matched with timely diagnosis and treatment.
India has also demonstrated, through polio eradication and Covid vaccination, that it can run large, decentralised public-health programmes at scale, with accuracy and efficiency.
For years, October has turned pink with campaigns urging women to “be aware”. Awareness is vital, but awareness alone does not save lives. Intelligence built into systems that can identify who is at risk, respond early, and ensure that no woman is left behind, is crucial for protection.
Risk-adapted screening is no longer a theoretical aspiration; the early results of the WISDOM study have lent it clinical legitimacy. The leap forward in breast-cancer screening for our country won’t come from doing more mammograms. It will come from doing the right screening for the right woman, at the right time.
The writer is consultant and breast oncosurgeon
Unlike Western countries, where breast cancer is predominantly a post-menopausal disease, the median age at diagnosis in India is just 47 years, nearly a decade younger, reducing mammography’s sensitivity and increasing the risk of missed cancers. 
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