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

The purpose of this updated guidance statement is to guide internal medicine physicians and other clinicians on screening for breast cancer in asymptomatic, average-risk adult females.

The American College of Physicians updated its guidance statement on screening for breast cancer using high-quality clinical guidelines from national guideline developers around the world.

In asymptomatic, average-risk females aged 40 to 49 years, clinicians should discuss the female's risk of breast cancer, values and preferences, and uncertainty around benefits and harms of screening for breast cancer. 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 (biennial).

In asymptomatic, average-risk females aged 50 to 74 years, clinicians should use biennial mammography for screening for breast cancer.

In asymptomatic, average-risk females aged 75 years or older or asymptomatic, average-risk females with a limited life expectancy, clinicians should discuss discontinuation of breast cancer screening based on shared decision making that includes the female's risk of breast cancer, values and preferences, and uncertainty around benefits and harms of screening for breast cancer.

In asymptomatic, average-risk adult females with breast density of Breast Imaging Reporting and Data System (BI-RADS) category C or D, clinicians should consider using supplemental digital breast tomosynthesis based on benefits, harms, additional radiation exposure, availability, values and preferences, and cost.

In asymptomatic, average-risk adult females with breast density of BI-RADS category C or D, clinicians should not use supplemental magnetic resonance imaging or ultrasound.

Published by Annals of internal medicine, 2026. The guideline itself is at the source linked here.

doi.org/10.7326/ANNALS-25-05116