ACP Recommends Biennial Mammography for Women Aged 50–74 Years
USA: The American College of Physicians (ACP) has reaffirmed its recommendation for biennial breast cancer screening from ages 50 to 74 years for asymptomatic, average-risk women, while emphasizing shared decision-making for women in their 40s and those aged 75 years or older. The updated guidance also provides specific recommendations for women with dense breasts, an area where screening strategies remain debated.
The recommendations are outlined in the 2026 document, “Screening for Breast Cancer in Asymptomatic, Average-Risk Adult Females: A Guidance Statement from the American College of Physicians (Version 2).” The guidance, published in the Annals of Internal Medicine, synthesizes evidence from systematic reviews informing previous recommendations, as well as guidance from Canadian and European organizations.
The ACP's position differs from the 2024 U.S. Preventive Services Task Force (USPSTF) recommendation, which advises biennial mammography beginning at age 40. The ACP continues to support starting routine screening at age 50, citing the balance between potential benefits and harms of screening. The recommendations apply to people assigned female at birth who are considered to have average breast cancer risk.
Key Recommendations:
- Screen women aged 50–74 years every 2 years: The ACP recommends biennial mammography for this age group, with moderate-certainty evidence indicating a net benefit in reducing breast cancer-related mortality.
- Use shared decision-making for women aged 40–49 years: Clinicians should discuss the potential benefits and harms of screening with women in this age group. Those who remain uncertain after counseling may reasonably defer screening, while those who elect to undergo mammography should be screened every 2 years.
- Discuss stopping screening at age 75 or older: Clinicians should engage older women in discussions about discontinuing mammography because the mortality benefit of continued screening remains uncertain and the likelihood of overdiagnosis increases with age.
- Consider digital breast tomosynthesis for dense breasts: Supplemental digital breast tomosynthesis (DBT) may be considered in women with dense breasts, which are an independent risk factor for breast cancer but do not by themselves place women in a high-risk category.
- Do not routinely add MRI or ultrasound for dense breasts: The ACP does not recommend supplemental breast MRI or ultrasound for average-risk women with dense breast tissue.
The updated guidance highlights the continuing differences among major organizations regarding the appropriate age to begin screening, screening frequency, and preferred imaging modalities. These differences can create practical challenges when patients receive conflicting recommendations from different clinicians or from radiology reports.
The ACP maintains that screening decisions should incorporate the individual's age, risk profile, preferences, and the potential benefits and harms of mammography. For women outside the 50–74-year age range, the emphasis on shared decision-making allows clinicians and patients to determine whether screening aligns with the patient's circumstances and values.
Overall, the recommendations reinforce a risk- and age-based approach to breast cancer screening, while acknowledging the uncertainty surrounding screening strategies in younger and older women and the management of dense breast tissue.
Reference:
Qaseem A, 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 2026 Apr 17; [e-pub]. DOI: 10.7326/ANNALS-25-05116.
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