New guidance from the American College of Physicians (ACP) says all average-risk females between ages 50 to 74 should receive biennial screening mammography for breast cancer, and that females between the ages of 40 and 49 should discuss with their doctor their risk for breast cancer and the benefits and harms of screening. According to the panel responsible for the guidance, this is because harms of screening—such as false-positive results, psychological distress, overdiagnosis, overtreatment, additional testing, and radiation exposure—may outweigh the uncertain benefits in this population. ACP's advice was presented at the breaking news scientific plenary session "New in Annals of Internal Medicine: Hear it First from the Authors" during the ACP Internal Medicine Meeting 2026. The paper was also published by Qaseem et al in Annals of Internal Medicine.
The guidance statement from the ACP also provides guidance on when to discontinue breast cancer screening and how to approach screening for females with dense breasts. The ACP guidance states that asymptomatic, average‑risk females who are 75 years or older, or those with a limited life expectancy, should discuss stopping routine screening with their doctor. This is because the benefits of screening beyond age 74 are reduced or uncertain, while potential harms, such as overdiagnosis, become more likely with increasing age. For asymptomatic, average‑risk females who have dense breasts, ACP advises doctors to consider supplemental digital breast tomosynthesis (DBT). Decisions should consider potential benefits and harms, radiation exposure, availability, patient values and preferences, and cost. However, ACP advises against using supplemental magnetic resonance imaging (MRI) or ultrasound for screening in this population.
The guidance statement was developed by ACP’s Clinical Guidelines Committee, which defined average risk as females who do not have a personal history of breast cancer or diagnosis of a high-risk breast lesion, a genetic mutation such as BRCA1/2 that is known to increase risk, another familial breast cancer risk syndrome, or a history of high-dose radiation therapy to the chest at a young age.
ACR and SBI Disagree
Following the release of the ACP guidance statement, the American College of Radiology (ACR) and Society of Breast Imaging (SBI) issued a joint statement disagreeing with the ACP’s stance.
The two societies wrote:
New American College of Physicians breast cancer screening guidelines rely on outdated and hyperbolic information, will cause continued confusion among women, and may contribute to thousands of additional breast cancer deaths each year. Thousands more women would endure extensive surgery, mastectomies and chemotherapy for advanced cancers than if their cancers were found early by an annual mammogram.
ACR and SBI urge women to start annual screening at age 40. The ACR also recommends that women have a breast cancer risk assessment by age 25. Those at higher risk for breast cancer should talk to their doctor about starting to screen prior to age 40 and additional screening methods—particularly African American women, certain Jewish women, and those with genetic mutations or strong family history of breast cancer.
Most experts do not support delayed or less frequent breast cancer screening. The United States Preventive Services Task Force (USPSTF), American Cancer Society, ACR, and SBI agree that the most lives and years of life are saved by starting annual screening at age 40.
ACP recommendations conflict with guidelines from nearly every other national society—especially those with cancer expertise, such as the National Comprehensive Cancer Network (NCCN), ACR, SBI, the American Society of Surgical Oncology, and the American Society of Breast Surgeons. ACR and SBI respect ACP’s efforts to advocate for our shared patients across many medical conditions and indications, but ask ACP to defer to breast cancer diagnosis and treatment experts regarding this matter.
Breast cancer is one of the leading causes of death in 40–49-year-old women in the United States and screening is specifically performed to prevent death from breast cancer. Screening only women ages 50–74 every other year—as called for by ACP—may result in up to 10,000 additional, and unnecessary, breast cancer deaths in the United States each year. ACP failure to recommend exams beyond DBT for screening women with dense breasts is also out of step with current research, which shows the need to go beyond DBT to help find cancer in these women.
National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results data show that, since screening became widespread in the 1980s, the U.S. breast cancer death rate in women has dropped 40%. Women screened regularly have a 47% lower risk of breast cancer death within 20 years of diagnosis than those not regularly screened. Regular mammography use cuts the risk of breast cancer death nearly in half, according to multiple studies.
NCI/Cancer Intervention and Surveillance Modeling Network models show a major decline in deaths in women screened annually vs biennially. Swedish data shows chemotherapy is much more effective in screened women vs unscreened women.
Among Asian, Black, and Hispanic women, one-third of all breast cancers are diagnosed under age 50—so starting screening at age 50 may increase breast cancer death rates in these women. For women over age 74, screening mammography significantly reduces breast cancer deaths, and the need for aggressive surgeries and chemotherapy. Additionally, many women over age 74 often choose to have treatment when diagnosed for breast cancer.
Screening risks—which are nonlethal—are overstated due to faulty assumptions, methodology, and hyperbole in articles on which these claims are based. High overdiagnosis claims are not well-founded. Such claims based on modeling studies are inflated. Well-designed studies provide an overall breast cancer overdiagnosis estimate of 10% or less. Screening-detected breast cancers do not disappear or regress if left untreated.
So-called false positive exams (recalls from screening) are usually resolved by the woman coming back to get additional mammographic views, ultrasound, or MRI. Anxiety from an inconclusive mammogram result or false positive is brief with no lasting health effects. Nearly all women who have had a false-positive exam still endorse regular screening.
