ACP Issues New Guidance on Breast Cancer Screening in Average-Risk Women, With Carolyn Crandall, MD, MS

The American College of Physicians has issued an updated guidance statement in the Annals of Internal Medicine outlining recommendations for breast cancer screening in asymptomatic, average-risk adult females, with a focus on individualized decision-making and evidence-based use of mammography.

The updated guidance recommends biennial mammography as the standard screening approach for females aged 50 to 74 years, while emphasizing a more individualized approach for those aged 40 to 49 years. The recommendations are based on a synthesis of high-quality clinical guidelines from national and international organizations and are intended to support primary care clinicians in aligning screening practices with current evidence.

For females aged 40 to 49 years, ACP advises clinicians to engage in shared decision-making discussions that incorporate breast cancer risk, patient values and preferences, and the uncertainty surrounding the balance of benefits and harms of screening. If, after these discussions, a patient chooses to undergo screening, clinicians should initiate biennial mammography.

In contrast, for females aged 50 to 74 years, ACP recommends routine biennial mammography without qualification, reflecting stronger evidence supporting net benefit in this age group. For females aged 75 years or older, or those with limited life expectancy, the guidance recommends discussing discontinuation of screening based on shared decision-making, again incorporating patient preferences and clinical context.

The guidance also addresses screening considerations for women with dense breast tissue. In those with Breast Imaging Reporting and Data System (BI-RADS) category C or D density, clinicians may consider supplemental digital breast tomosynthesis, taking into account potential benefits, harms, additional radiation exposure, availability, cost, and patient preferences. However, ACP recommends against the use of supplemental magnetic resonance imaging or ultrasound in this population.

Overall, the updated recommendations reinforce a risk-based and patient-centered approach to breast cancer screening, particularly in age groups where the balance of benefits and harms is less certain. For primary care physicians, the guidance provides a structured framework to support conversations with patients and guide appropriate use of screening modalities.

Reference:

1. Qaseem A, Harrod CS, Balk EM, et al. Screening for breast cancer in asymptomatic, average-risk adult females: A guidance statement from the American College of Physicians (Version 2). Ann Intern Med. Published online April 17, 2026. doi:10.7326/ANNALS-25-05116