Some middle-aged women should not automatically receive regular mammography, a U.S.-based group of doctors said in new guidance.
Women aged 40 to 49 who are at average risk of breast cancer should discuss with their doctors the benefits and harms of screening, as well as the risk of the cancer, the American College of Physicians said in the guidance, released on April 17 in the group’s Annals of Internal Medicine journal.
“Following shared decision making, if a female in this population prefers to get screened for breast cancer, clinicians should then initiate screening mammography every 2 years,” the guidance states.
Women aged 50 to 74 who show no symptoms and are deemed at average risk for breast cancer should receive mammography on a biennial basis, the group recommended.
Women aged 75 and older, or asymptomatic women with average risk and limited life expectancy, should discuss halting mammography, according to the updated guidance. The conversations with their doctors should include the “uncertainty around benefits and harms of screening for breast cancer.”
The risks include false positives.
Hundreds of thousands of cases of breast cancer are diagnosed in women in the United States each year, including an estimated 316,950 cases in 2025, according to the U.S. government. Older women are more likely to be diagnosed with breast cancer. About four in five women aged 50 to 74 currently undergo biennial mammography.
The guidance was developed after reviewing five guidelines, including guidelines from the U.S. Preventive Services Task Force, which is an independent panel that provides recommendations to the U.S. government, and guidance from three Brazilian organizations. Other guidelines were omitted because they have not been updated in recent years.
“Screening for breast cancer is essential and should be guided by the best available evidence,” Dr. Jason Goldman, immediate past president of the American College of Physicians, said in a statement.
He said the new guidance is meant “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.”
The college has some 163,000 members, many of whom are internal medicine doctors.
Women are at average risk of breast cancer if they do not have a history of breast cancer or a high-risk breast lesion, a genetic mutation known to increase risk, another syndrome of breast cancer in the family, or a history of high-dose radiation therapy, according to the group.
Divergence
The new recommendations differ for certain ages from those offered by other groups.The U.S. Preventive Services Task Force, for instance, recommends biennial screening for all women aged 40 to 74. It also says there is not sufficient evidence to support offering mammography to women 75 and older.
The American College of Radiology and Society of Breast Imaging recommend annual screening for all women aged 40 and older.
They said in response to the new guidelines that delaying breast cancer screening could result in up to 10,000 additional breast cancer deaths in the United States each year. They also said that false positives are usually resolved by additional testing, such as ultrasounds.
