The American College of Physicians (ACP) released a new guidance statement in the Annals of Internal Medicine in April 2026, reigniting debate over breast cancer screening age and frequency.
A comprehensive review by researchers from Trinity College Dublin and St James’s Hospital, published in the Cochrane Database of Systematic Reviews, also found that current statistical tools used to estimate breast cancer risk may fall short in pinpointing individual risk in women with a family history of the disease.
Currently, there is no international consensus on routine screening mammography, and many major medical and health organizations offer different guidance.
The main point of contention between such practices boils down to a debate of pros versus cons. On one hand, the life-saving benefits of early cancer detection are apparent; however, there is also some concern around overdiagnosis, false positives, patient anxiety, and unnecessary biopsies.
It is important to note that most of the current advice is geared toward women at average risk of breast cancer, namely those without a personal history of breast cancer, high familial risk, or those carrying high-risk genetic mutations.
Medical News Today spoke to the following two experts to get clarity on the best screening age and methods for breast cancer prevention and detection:
The USPSTF updated its formal guidance in 2024, underscoring the importance of earlier screening:
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The ACS guidelines highlight individual decision making power as a key factor in screening:
The American College of Radiology (ACR) & American Society of Breast Surgeons (ASBrS) combine the advice of the USPSTF and ACS, and advocate for a more aggressive preventive screening schedule:
Rourke said baseline screening usually begins around age 40 and should be repeated annually.
“My personal bias is that a baseline screening mammogram at [age] 35 can go a long way. Determining when to start and how often to get a mammogram has become unnecessarily confusing for women (and even for doctors and care teams),” she said, drawing attention to recent conflicting advice.
“The USPSTF issued the new recommendation based mainly on the limitations of mammography technology, in direct opposition to the professional cancer organizations such as the ACS, the ACR, the SSO, the ASBrS, and the ASCO, who all stood by the original recommendation of beginning at age 40. This became so confusing that no one knew what to do, and many still don’t,” Rourke explained.
“While the USPSTF has since rolled back its original recommendation, the ambiguity remains. With all the confusion, women have been lost to follow-up and have fallen through the cracks by not going for their yearly [mammograms],” she continued.
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“For an average risk woman, I recommend screening at the age of 40 years, and it is consistent with NCCN guidelines. If the woman is healthy with a life expectancy of more than 10 years and is willing to go for a mammogram, then I offer it,” Raza said.
“Annual mammography is generally recommended by most of the guidelines, whereas USPSTF recommends a biennial mammogram after the age of 40,” he added.
Currently, there is no substitute for a mammogram in screening the average-risk population of women, Rourke said.
She said that while whole breast ultrasounds can also be an option for some women, the ACR and NCCN do not recommend it.
Raza said that, prior to mammograms and before the minimum screening age, he advises his patients to perform self-examinations and go in for clinical breast examinations.
“Moreover, I also employ breast cancer risk assessment tools before starting mammographic screening. Women with strong family history of breast cancer, BRCA mutations, history of prior radiation therapy to the chest are generally considered for mammography instead of other screening methods,” he said.
“My advice: you still need the mammogram, but an ultrasound can be a useful additional test. Ultrasounds can reveal the tissue composition and blood flow in any area of concern. It is a standard, usually painless, additional test that helps radiologists further characterize and better determine their level of suspicion,” she said.
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Raza said the concerns about false positives and overdiagnosis were largely outweighed by the benefits of early diagnosis and treatment.
“[A]lthough the breast cancer treatment may cause suffering and anxiety, [that] suffering is likely worth the gain from the potential reduction in breast cancer mortality. According to most of the guidelines, including NCCN, the risk of false positives and overdiagnosis is outweighed by the benefit of mortality reduction,” he said.
“In most cases, your mammogram will find nothing. Statistically, 1,000 screening mammograms result in about 100 callbacks. From there, about 30 women will get a biopsy, and about 5 will get news that they have cancer. The odds are good that your mammogram will be normal,” Rourke said.
Rourke reiterated that mammograms are not perfect and may not always be 100% accurate.
“Sometimes, it’s hard for the radiologist to tell if there’s a problem or not. If you are called back, you have two realistic choices: go get the additional diagnostic imaging or consider finding another qualified breast center to get a different set of eyes on your case,” she said.
Raza explained that high breast density and breast tissue may make mammograms less effective as they may obscure or mask the cancers.
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“Breasts are made up of glandular tissue (the breastfeeding tissue) and fat. The glandular tissue looks white on a mammogram, and fat looks dark gray. Cancer is a white spot on a mammogram. The more glandular tissue, the whiter the background, so the harder it is to find a white cancer spot. This is why density matters,” Rourke chimed in.
“That’s why mammograms have limitations, especially in younger women and any woman with dense breasts,” she added.
“If you have fatty breasts, then the mammogram is likely sufficient for finding cancer early. If you have dense breasts, an additional imaging test may be needed to fully evaluate your breasts for cancer,” he continued.
Rourke said that depending on breast density, doctors may recommend supplemental imaging such as ultrasound, MRI, contrast-enhanced mammography, MBI, and PEM.
“Ultrasound by itself is not a good screening tool because it is operator-dependent, variable, and has too many false positives to be worthwhile. However, it can be used for supplemental screening in patients with dense breasts,” Rourke said.
I reassure my patients by explaining the procedure in detail that it is a brief painless procedure with some discomfort when the breasts are being compressed by the probe. Moreover, radiation exposure is low and within the acceptable safety standards,” he said.
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He also reiterated that an abnormal mammogram does not necessarily mean cancer and that early detection means a higher chance of curing.
Rourke, meanwhile, explained how the procedure may cause more discomfort in some women.
“Unfortunately, if your breasts are on the smaller end, mammos can be more painful. Mammograms are generally a little uncomfortable, but there are ways to minimize this: find a reputable breast center, avoid scheduling your mammo when your breasts are tender due to your period, take an over-the-counter pain reliever before, after, or both,” Rourke said.
“Your breasts might feel squished and flat for a couple of days afterward and may even be sore, but it’s worth it to find cancer as early as possible, get treatment, and get back to living your life,” she said.
“Apart from age, I consider the genetic risk factors like the presence of BRCA gene mutations, PALB2, TP53, CHEK2, and ATM mutations. Moreover, a first-degree relative at a young age with breast cancer or a family history of ovarian, pancreatic, or male breast cancer takes the lead,” Raza said.
He also said that obesity and physical inactivity are among the common lifestyle risk factors that should be taken into consideration.
