- Ages 40–49: shared decision-making first. Harms (false positives, overdiagnosis, psychological distress) may outweigh uncertain benefits for most women in this age group. Screening is a personal choice — if preferred after discussion, biennial mammography should be offered.
- Ages 50–74: biennial mammography is recommended. This is where benefits most clearly outweigh harms. Annual screening adds false positives and patient burden without clear mortality benefit over biennial screening.
- Ages 75+: discuss stopping. Evidence does not support continued screening in this group — overdiagnosis and unnecessary testing increase while mortality benefit diminishes. Discontinuation should be guided by shared decision-making and life expectancy.
- Dense breasts (BI-RADS C or D): consider supplemental DBT, avoid MRI or ultrasound. Digital breast tomosynthesis (DBT) may improve cancer detection with fewer false-positive recalls, but MRI and ultrasound carry higher false-positive rates, serious adverse events, and insufficient mortality evidence to justify routine use.
- More screening ≠ better outcomes. Annual mammography increases false positives, benign biopsies, overdiagnosis, and radiation exposure without proportional mortality reduction. High-quality biennial screening in the right program remains the optimal approach.
ACP Updates Breast Cancer Screening Guidance
Conexiant
April 17, 2026
