Abstract PS3-02-09: Recruitment Strategy Success and Challenges in WISDOM 1.0: A Nationwide Risk-Based Breast Cancer Screening Trial

Abstract Background: The Women Informed to Screen Depending on Measures of risk (WISDOM) Study 1.0 (2016-2023; NCT02620852) is testing a novel, personalized approach to breast cancer screening compared to annual mammography. As a large-scale screening trial, WISDOM aimed to enrolled individuals ages 40-74 with no personal history of breast cancer using a preference tolerant randomized trial design that aimed to reflect the heterogeneity of the U.S. population. The goal of this analysis is to evaluate the recruitment strategies employed during WISDOM 1.0 and assess their effectiveness in building a geographically and racially diverse cohort of U.S. women for breast cancer screening research. Methods: We analyzed enrollment and recruitment data sources including participant-reported responses to the ‘How You Heard’ (HYH) survey question administered at enrollment. Recruitment channels were grouped into categories (e.g., email from doctor, flyer/brochure, social media, friend/family referral), and stratified analyses were performed by recruitment site and self-reported race/ethnicity. We conducted analyses to evaluate volume and proportion of participants recruited by each strategy, rates by outreach method over time, differences by geography and participant demographics. Results: Between August 2016 and February 2023, WISDOM 1.0 registered 70575 women, consented 55284, and fully enrolled 46289 participants. Initial recruitment was limited to the Athena Breast Health Network within the University of California system (2016 -2017) but expanded through collaborations with external institutions and health systems and later to nationwide virtual enrollment.The recruitment method that yielded the most participants during the trial was emails from medical centers, MyChart, and physicians (40% of total enrollment). This was followed by family/friend referrals (10%) and emails from a Veteran’s Affairs (VA) recruitment partnership (6%). During the VA outreach, this strategy accounted for 25% of enrollment driving upward spikes in participation particularly in women of color. Other strategies included health insurance plan (4%), news article/radio/TV (4.5%) and social media (2.5%). WISDOM’s cohort diversity improved over the course of the trial, led by efforts from our Community Leadership Advisory Board, new recruitment centers, nationwide collaborations, and partnership with the VA. Over the course of the trial, there was a reduction in white, Non-Hispanic participants from 83% pre-community engagement efforts to 60% after new strategies were implemented (average 75%). The VA contributed to 26% of Black/African American participant enrollment, 10% of Hispanic participants, and 9% each for American Indian/Alaska Native (AI/AN) and Native Hawaiian/Pacific Islanders (NH/PI). Family/friend referrals accounted for over 7% of NH/PI but less than 4% for Black/AA, and only 1.5% for AI/AN. NH/PI participants were less likely to report physician/medical center (31%) and had the highest proportion of other options such as community organizations (9%) and health insurance plan (9%). Discussion: WISDOM 1.0 demonstrated the feasibility of recruiting a large, nationwide cohort for a personalized breast cancer screening trial using multi-modal, decentralized outreach. Physician emails and MyChart emerged as the highest-yield strategy, leveraging pre-existing patient trust and communication channels. The VA collaboration stands out as a highly scalable and demographically impactful approach while friend/family referrals offered downstream enrollment benefits. WISDOM 2.0 launched in June 2023 leveraging WISDOM 1.0’s recruitment approaches with an emphasis on refining high-yield, low-barrier strategies, amplifying trusted voices, and integrating culturally responsive approaches. Citation Format: A. S. Fiscalini, T. Glatt, S. Goodman, C. Kaplan, A. Z. LaCroix, L. van 't Veer, M. Scheuner, P. Sales, A. Petruse, A. Naeim, A. Kaster, J. Wernisch, O. I. Olopade, B. Gonzales, H. L. Park, A. D. Borowsky, S. A. Raouf, J. Atamer, K. Leggat-Barr, J. Esserman, I. Cabaleiro, R. Lancaster, L. Anderson, D. Heditsian, S. Brain, V. Lee, D. Moorehead, B. A. Parker, A. Torres, L. Sabacan, L. Johansen, X. Calderon, A. Rocha, A. Verma, J. Cover, T. Miller, M. Che, N. Kim, T. Lewis, S. Kapoor, R. Soonavala, D. Goodman-Gruen, S. D. Stewart, R. A. Hiatt, N. Wenger, H. Anton-Culver, I. A. Soto, M. Eklund, K. F. Rhoads, L. J. Esserman. Recruitment Strategy Success and Challenges in WISDOM 1.0: A Nationwide Risk-Based Breast Cancer Screening Trial [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-02-09.