Leading breast cancer surgeon warns the ‘one-size-fits-all approach’ for breast screening is outdated

Australia must urgently shift from the traditional 'one-size-fits-all' breast screening model to a tailored, risk-based approach to detect cancer earlier, save more lives and make better use of health resources urged Associate Professor Sanjay Warrier.
 

This was the message delivered by Associate Professor Warrier as a key note speaker at the Breast Cancer Trials (BCT) Annual Scientific Meeting this year which was held in Tasmania in July. The event addressed issues such as the evolving role of immunotherapies and new approaches for managing breast cancer in younger patients.
 

Breast cancer is the most common cancer in Australian women, with more than 21,000 diagnoses and 3,300 deaths in 2024. Incidence rates are continuing to rise, particularly in the Western Pacific region.
 

"While our national screening program has saved countless lives, it is still largely age-based," Associate Professor Warrier said.
 

"This approach misses opportunities to detect cancers earlier in high-risk women and can lead to unnecessary procedures in low-risk women. The future is tailored breast screening where screening frequency and technology are matched to a woman's personal risk profile."
 

Associate Professor Warrier is one of the world's leading breast health researchers and breast cancer surgeons who has built a highly respected practice in Sydney. The practice spans three locations with its main surgical centre located at the Chris O'Brien Lifehouse in Camperdown, and the other sites at BMA House, Macquarie Street, Sydney and Bondi Junction Medical, Oxford Street, Bondi Junction.
 

In addition to Associate Professor Warrier's breast health and surgical work, he also dedicates considerable time to research exploring and developing advancements in breast cancer prevention, detection and treatments to improve outcomes for patients. He also codeveloped Australasia's first Master of Advanced Surgery (Breast Surgery) which is delivered through the University of Sydney.
 

Moving beyond age-based screening
 

Tailored breast screening moves beyond using age alone to determine screening schedules. It uses validated tools, such as the iPrevent risk calculator, to assess a woman's individual profile, including family history, genetic factors, breast density, hormonal exposure and lifestyle.

Two women of the same age can have vastly different risks. For example, Mary, aged 52, has dense breasts and a moderate risk for breast cancer. Under current guidelines, she is recalled every two years, but her breast density means cancers could be harder to detect, suggesting a need for more frequent or enhanced imaging. Rosa, also 52, has low-density breasts and no additional risk factors, meaning she may safely continue with two-yearly screening without extra interventions.
 

"Tailored screening ensures both women get the right level of surveillance for their situation," Associate Professor Warrier said.
 

Why the change is urgent
 

The benefits of tailored screening are already supported by strong international evidence and endorsed by bodies such as NICE in the UK and the RACGP in Australia. Studies show tailored interventions increase mammography uptake, reduce interval cancers and lower false positive rates.
 

The Australian Government-funded ROSA Project, completed in 2023, delivered 25 recommendations to optimise screening, including the adoption of risk-based models. Breast density remains a critical factor, with women who have dense breasts not only facing a higher risk of cancer but also experiencing reduced detection rates on standard mammograms. For these women, supplemental imaging such as MRI or contrast-enhanced mammography could be life- saving.
 

Overcoming challenges and delivering benefits
 

Implementing tailored screening nationwide will require adoption of validated risk assessment tools, equitable access across all communities, strong patient education and funding models that support additional imaging for women who need it. While there are challenges, the payoff is significant and will result in earlier detection in high-risk women, fewer unnecessary procedures in low-risk women, more efficient use of health resources and ultimately a reduction in breast cancer deaths.
 

Knowing your normal and your risk
 

Associate Professor Warrier also encourages women to become familiar with their own breasts and be alert to any changes, regardless of their screening schedule. Asymmetry is common and usually harmless, but if it is new, rapidly changing or accompanied by symptoms such as nipple inversion, skin dimpling or swelling, it should be investigated immediately.
 

"There's no one-size-fits-all answer in breast health. Knowing your normal and understanding your risk is the first step to early detection," he said.
 

More information on breast cancer detection and screening is available at www.drsanjaywarrier.com.au.
 

About Associate Professor Sanjay Warrier
 

Associate Professor Sanjay Warrier is a past President and current committee member of Breast Surgeons of Australia and New Zealand (BreastSurgANZ). His views are those of his own, not BreastSurgANZ. Associate Professor Warrier's surgery is located at the Chris O'Brien Lifehouse and he also has clinics at Oxford Street, Bondi Junction and Macquarie Street, Sydney. He is published in numerous peer-reviewed journals and won the Royal Prince Alfred Hospital's Patron's Prize for best scientific research.