Annals of Internal MedicineScreening for Breast Cancer in Asymptomatic, Average-Risk Adult Females: A Guidance Statement From the American College of Physicians (Version 2)

✅ Guideline Update

ACP Version 2 guidance on breast cancer screening in asymptomatic, average-risk females recommends shared decision-making for ages 40-49, biennial mammography for ages 50-74, and against supplemental MRI or ultrasound for dense breasts. Supplemental DBT may be considered for BI-RADS C or D.

Clinical Considerations

• ACP departs from USPSTF by not recommending routine biennial mammography at age 40, citing harms outweighing marginal mortality benefit in this group
• Annual mammography over 10 years carries a 50% to 60% false-positive rate, reducing future screening adherence
• Overdiagnosis and overtreatment rise with age, particularly in women 70 and older with slow-growing tumors
• Supplemental MRI in dense breasts produced 80 false-positive recalls per 1,000 screened alongside serious adverse event risk

Practice Applications

• Initiate shared decision-making for ages 40-49 and proceed to biennial mammography only if patient prefers screening
• Use biennial mammography as standard for ages 50-74 with average risk
• Discuss discontinuation at age 75 or with limited life expectancy, reassessing every 2 years
• Avoid supplemental MRI and ultrasound in dense breasts; consider supplemental DBT after negative mammography

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