Ann Intern Med
Breast cancer screening update: ACP doubles down on biennial mammography
Clinical takeaway: Offer biennial mammography for average‑risk women ages 50–74; use shared decision‑making for women ages 40–49 and consider stopping routine screening at age 75 or with limited life expectancy.
The American College of Physicians (ACP) has released Version 2 of its guidance on screening for breast cancer in asymptomatic, average‑risk adult females, refining earlier recommendations and reinforcing a high‑value, evidence‑based approach to screening. The updated guidance was published in Annals of Internal Medicine and presented as a breaking news scientific plenary session at this year’s ACP Annual Meeting in San Francisco.
For women ages 50 to 74, ACP continues to recommend biennial screening mammography, concluding that this interval offers the best balance of benefit and harm for most average‑risk patients. Evidence suggests biennial screening provides similar reductions in breast cancer mortality compared with more frequent screening, while substantially limiting false‑positive results, unnecessary biopsies, overdiagnosis, and overtreatment.
In women ages 40 to 49, the guidance stops short of routine screening and instead emphasizes individualized, shared decision‑making. Clinicians are advised to discuss personal breast cancer risk, patient preferences, and the potential harms of screening, which may outweigh the uncertain benefits in this age group. Women who do not express a strong preference for screening should not be screened routinely.
For women age 75 and older, or those with limited life expectancy, ACP recommends discussing whether to discontinue routine screening. The guidance notes that benefits of screening beyond age 74 are reduced or uncertain, while the likelihood of harms such as overdiagnosis increases with age.
The guidance also addresses breast density. For average‑risk women with dense breasts, clinicians should consider digital breast tomosynthesis, factoring in potential benefits, harms, radiation exposure, availability, cost, and patient values. ACP advises against the use of supplemental MRI or ultrasound for screening in this population.
The recommendations apply only to average‑risk individuals, defined as those without a personal history of breast cancer, high‑risk breast lesions, known pathogenic genetic mutations such as BRCA1 or BRCA2, familial breast cancer syndromes, or a history of high‑dose chest radiation at a young age.
Reflecting on the guidance, ACP leaders emphasized clarity and restraint in screening. “The evidence shows that the best balance of benefits and harms for most women is to undergo breast cancer screening with mammography every other year between the ages of 50 and 74,” the authors noted when presenting the update at the ACP meeting.
Source: Qaseem A, et al; Clinical Guidelines Committee of the American College of Physicians. (2026, April 17). Ann Intern Med. Screening for Breast Cancer in Asymptomatic, Average-Risk Adult Females: A Guidance Statement From the American College of Physicians (Version 2)