Approximately 30% of all new female cancer cases each year are breast cancer, making it one of the most prevalent malignancies among American women. A woman in the United States will typically have a 1 in 8 chance of getting breast cancer.
The majority of women with breast cancer are 50 years of age or older, and the disease primarily affects middle-aged and older women. Although it is uncommon, it is possible to be diagnosed with breast cancer before the age of 45. The typical age at diagnosis is 62.
Breast cancer screening is essential because it allows for early detection, frequently before symptoms manifest and when treatment is most effective. The possible negative effects of screening, such as false positive results, psychological discomfort, and extra testing, may, however, exceed the unclear advantages in this demographic for those who are less vulnerable.
The ACP updated earlier recommendations and clarified when to start and discontinue screening in a new guidance statement that was delivered at the ACP’s 2026 Internal Medicine Meeting and published in the Annals of Internal Medicine.
What is said in the new guidelines?
According to the ACP’s revised guidelines, all asymptomatic females between the ages of 50 and 74 who are at average risk of breast cancer should have a mammogram every two years.
According to the guidelines, women who do not have any known high-risk gene mutations, such as BRCA1 or BRCA2, a personal or family history of breast cancer, or a history of high-dose chest radiation at an early age are considered average-risk.
The organization comes to the conclusion that this group is most likely to benefit from mammography screening and is at the highest risk of getting breast cancer based on high-quality clinical guidelines from national guideline developers worldwide.
The initial author of the new guidelines and Senior Vice President of Clinical Policy and the Center for Evidence Reviews at the American College of Physicians (ACP), Amir Qaseem, MD, PhD, MHA, MGIN, FRCP, FACP, discussed the main reasons for the biennial suggestion with Medical News Today.
Compared to biannual screening, annual screening produced higher false-positive recalls and biopsies. According to him, “current evidence does not suggest an additional advantage of annual screening above biannual screening, and annual screening adds significant patient hardship and expenditures.”
Additionally, the ACP urges individuals between the ages of 40 and 49 to talk to their doctor about the advantages and disadvantages of screening for breast cancer, even if other guidelines may recommend screening every other year beginning at age 40.
Clinicians should employ shared decision making for asymptomatic, average-risk females between the ages of 40 and 49. It is an individual decision. Clinicians should talk about each patient’s risk for breast cancer, her values and preferences, and any doubts she may have about the advantages and disadvantages of breast cancer screening, Qaseem told MNT.
“There is no difference in advanced breast cancers, but there is a tiny absolute reduction in mortality (only in ages 45 to 49 years), which needs to be evaluated against hazards,” he stated.
He went on to say, “These include overdiagnosis, overtreatment, false-negative findings, higher risk of additional testing, psychological anguish due to false positives, more radiation exposure, and false positive results can diminish adherence to future screening.”
Recommendations for older age groups on breast cancer screening
Screening in older groups is included in further ACP guidelines. The association suggests talking about whether to stop routine screening for women who are 75 years of age or older or who have a shortened life expectancy.
Qaseem told MNT, “Clinicians should discuss discontinuing breast cancer screening based on shared decision making in asymptomatic average risk females aged 75 years or older or with a low life expectancy.”
“Continuing screening after the age of 74 led to extra testing with or without biopsy and overdiagnoses, but there was no change in breast cancer mortality.”
Furthermore, supplemental digital breast tomosynthesis (DBT) may be used by clinicians for females with dense breast tissue, according to further guidelines.
“Based on the advantages, disadvantages, additional radiation exposure, availability, values and preferences, and costs, clinicians should think about utilizing supplemental DBT in females with breast density of BI-RADS category C or D.” However, Qaseem advised MNT that women with breast densities of BI RADS C or D should not undergo additional MRI or ultrasound.
When it comes to identifying cancer in people with thick breasts, DBT describes a 3D mammography method that might be better. This is crucial because, especially in those with dense breasts categorized as BI-RADS categories C and D, breast density might raise the risk of breast cancer and the possibility that a routine mammography will miss it.
Experts’ opinions on the new guidelines
The ACP states that its revised statement is intended to assist doctors in screening asymptomatic, average-risk adult females for breast cancer and to assist patients in navigating difficult trade-offs regarding screening frequency, age thresholds, and imaging alternatives.
The organization stresses that screening choices should be customized for each patient and informed by the best available data.
Health professionals, however, are worried that the ACP’s recommendations are based on out-of-date research and could lead to higher death rates.
Debra Patt, MD, PhD, MBA, Texas Oncology’s Executive Vice President of Public Policy and Strategy, shared her thoughts on the revised guidelines with MNT.
To be clear, yearly mammograms for average-risk women between the ages of 40 and 49 result in an earlier diagnosis and save lives. On the other hand, biannual mammography is a safe screening method for women over 50 with average breast density and average risk, according to Patt.
She underlined how crucial it is to talk to a professional about screening and various screening techniques.
“Maintaining excellent health includes cancer screening. Cancer screening is a strategy to lower your chance of developing chronic illness and maintain your body’s health, just like eating a balanced diet and exercising, Patt told MNT.
“If women with dense breasts (BI RADS C or D breasts) decide not to use an augmented screening technique, diagnosis will probably be delayed. Finally, women should always talk to their doctor about screening methods. An increased screening regimen may be necessary for women who have a high lifetime risk of cancer due to a significant family history or other circumstances, she continued.