ACP Recommends Biennial Mammograms for Average-Risk Women Ages 50-74

Most women start annual mammograms at age 40 to screen for breast cancer, but some experts question if that is too early and too often.

The American College of Physicians released new risk-based guidance on breast cancer screening, published in the Annals of Internal Medicine. It recommends that average-risk, asymptomatic women ages 50 to 74 get mammograms every two years.

Women ages 40 to 49 should discuss their breast cancer risk with a doctor and weigh screening benefits against harms.

Unnecessary screening can lead to false positives, psychological distress, over-diagnosis, over-treatment, extra tests and radiation exposure, the ACP warned.

For asymptomatic average-risk women 75 and older, or those with limited life expectancy, doctors can discuss stopping screening. "This is because the benefits of screening beyond age 74 are reduced or uncertain, while potential harms, such as over-diagnosis, become more likely with increasing age," the group said.

Women with dense breasts should have doctors consider supplemental digital breast tomosynthesis, or 3D mammography. "Decisions should consider potential benefits and harms, radiation exposure, availability, patient values and preferences, and cost," the ACP wrote. It advises against supplemental MRI or ultrasound for screening in this group.

The guidance comes from ACP’s Clinical Guidelines Committee, which defines average-risk women as those without a personal history of breast cancer, high-risk breast lesions, BRCA 1 or 2 mutations, familial breast cancer risk syndromes or chest radiation at a young age.

Dr. Jason M. Goldman, ACP president, said in a statement that breast cancer screening is essential and should follow the best evidence. "ACP developed this guidance to provide physicians and females with the information they need to make breast cancer screening decisions, including when to start and discontinue, how often to screen and which methods to use for screening, " he added.

Lauren Carcas, a medical oncologist at Miami Cancer Institute, part of Baptist Health South Florida, told Fox News Digital the guidelines add to confusion over screening recommendations. "Generally, this recommendation is based on a risk-based screening approach to determine who needs more frequent and/or aggressive screening versus who could safely space out screening frequency," she said.

That approach assumes all women have equal access to individualized risk discussions with primary care or gynecologic physicians, Carcas noted.

Biennial screenings could widen disparities and raise the chance of missing cancers in groups facing care barriers, she said.

The ACP advice differs from groups like the American Society of Breast Surgeons and the American College of Radiology/Society of Breast Imaging, which favor annual mammograms starting at 40.

Screening intervals remain the biggest dispute among medical societies and the screening task force, Carcas said. All major U.S. societies agree mammography should start at 40, but women should get a formal breast cancer risk assessment by age 25 to guide screening.

She disputed the ACP stance against supplemental MRI and ultrasound for dense breasts, in favor of DBT alone. Radiologic societies strongly recommend adding ultrasound and/or MRI for better imaging, Carcas said.

Women with a 20 percent or higher lifetime breast cancer risk count as high-risk and need annual screening with supplemental ultrasound and MRI consideration.

For average-risk women, discussions with physicians will shape whether to screen annually or every two years based on preferences.

No randomized trial has compared mortality risks of annual versus biennial screening, leaving an evidence gap, she said. Most women diagnosed with breast cancer would prefer early detection to avoid chemotherapy and aggressive treatments.

Carcas plans to keep recommending annual screenings to her patients and offering ultrasounds and MRIs as needed.