WISDOM (Women Informed to Screen Depending on Measures of Risk)

WISDOM is a pragmatic trial across the University of California health systems and partners in the Athena Breast Health Network, led by Laura Esserman and opened in 2016. Women choose to be randomised or to pick an arm. In the personalised arm, a risk assessment that includes a panel of breast cancer genes, polygenic risk, family history and breast density sets when screening starts, how often it happens and whether MRI is added; women at the lowest risk screen every two years from 50, those at the highest risk more often and earlier. The comparison arm is annual mammography from age 40.

The primary question is whether the personalised approach is not inferior in the rate of late-stage cancers, with false positives, biopsies, and take-up of preventive drugs as secondary outcomes. The trial is the largest test of the idea that screening should be a personal prescription rather than one rule for all, and its risk model and consent tools have been adopted by other programmes.