New ACP Breast Cancer Screening Guidelines Are a Step Backward that May Cost Lives

American College of Radiology and Society of Breast Imaging Statement:

WASHINGTON, April 17, 2026 /PRNewswire/ -- New American College of Physicians breast cancer screening guidelines rely on outdated and hyperbolic information, will cause continued confusion among women and may contribute to thousands of additional breast cancer deaths each year. Thousands more women would endure extensive surgery, mastectomies and chemotherapy for advanced cancers than if their cancers were found early by an annual mammogram.

The American College of Radiology^® (ACR^®) and Society of Breast Imaging (SBI) urge women to start annual screening at age 40ⁱ. The ACR also recommends that women have a breast cancer risk assessmentⁱⁱ by age 25. Those at higher risk for breast cancer should talk to their doctor about starting screening prior to age 40 and additional screening methods -- particularly African American women, certain Jewish women and those with genetic mutations or strong family history of breast cancer.

Most experts do not supportⁱⁱⁱ the delayed or less frequent breast cancer screening. The United States Preventive Services Task Force (USPSTF), American Cancer Society, ACR and SBI agree that the most lives and years of life are saved by starting annual screening at age 40^iv.

ACP recommendations conflict with guidelines from nearly every other national society – especially those with cancer expertise, such as the National Comprehensive Cancer Network (NCCN), ACR, SBI, the American Society of Surgical Oncology, and the American Society of Breast Surgeons. ACR and SBI respect ACP efforts to advocate for our shared patients across many medical conditions and indications but ask ACP to defer to breast cancer diagnosis and treatment experts regarding this matter.

Breast cancer is one of the leading causes of death in 40–49-year-old women in the United States and screening is specifically performed to prevent death from breast cancer. Screening only women ages 50-74 every other year – as called for by ACP – may result in up to 10,000 additional, and unnecessary, breast cancer deaths^v in the United States each year. ACP failure to recommend exams beyond digital breast tomosynthesis (DBT) for screening women with dense breasts is also out of step with current research, which shows the need to go beyond DBT to help find cancer in these women.

National Cancer Institute Surveillance, Epidemiology, and End Results^vi data show that, since screening became widespread in the 1980s, the US breast cancer death rate in women has dropped 40%. Women screened regularly have a 47% lower risk of breast cancer death^vii within 20 years of diagnosis than those not regularly screened. Regular mammography use cuts the risk of breast cancer death nearly in half^viii,ix.

NCI/Cancer Intervention and Surveillance Modeling Network models show a major decline^x in deaths in women screened annually vs. biennially. Swedish data shows^xi chemotherapy is much more effective in screened women^xii vs. unscreened women.

Among Asian, Black, and Hispanic women, one-third of all breast cancers are diagnosed under age 50, Starting screening at age 50 may increase breast cancer death rates in these women. For women over age 74, screening mammography significantly reduces breast cancer deaths, and the need for aggressive surgeries and chemotherapy. Women over age 74 often choose to have treatment when diagnosed for breast cancer.

Screening risks – which are non-lethal -- are overstated^xiii due to faulty assumptions, methodology and hyperbole in articles on which these claims are based. High overdiagnosis claims are not well-founded^xvii. Such claims based on modeling studies are inflated^xiv. Well-designed studies provide an overall breast cancer overdiagnosis estimate of 10% or less^xv,xvi,xvii]. Screening-detected breast cancers do not disappear or regress if left untreated^xviii.

So-called false positive exams (recalls from screening) are usually resolved by the woman coming back to get additional mammographic views, ultrasound or MRI. Anxiety from an inconclusive mammogram result or false positive is brief with no lasting health effects^xix. Nearly all women who have had a false-positive exam still endorse regular screening^xx.

References

ⁱ Monticciolo, D, Malak S, Friedewald S, Eby P, Newell M, Moy L, Destounis S, Leung J, Hendrick RE, Smetherman D. Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging. Journal of American College of Radiology. 2023.
ⁱⁱ Monticciolo D, Newell M, Moy L, Lee C, Destounis S. Breast Cancer Screening for Women at Higher-Than-Average Risk: Updated Recommendations from the ACR. Journal of the American College of Radiology. 2023.
ⁱⁱⁱ Radhakrishnan A, Nowak S, Parker A et al. Physician Breast Cancer Screening Recommendations Following Guideline Changes. JAMA Intern Med. 2017.
^iv Arleo E, Hendrick RE, Helvie M, Sickles E, Comparison of recommendations for screening mammography using CISNET models. Cancer. 2017.
^v Hendrick RE, Helvie M. United States Preventive Services Task Force Screening Mammography Recommendations: Science Ignored. American Journal of Roentgenology. 2011.
^vi National Cancer Institute. Cancer Stat Facts: Female Breast Cancer. 2024.
^vii Tabar L, Dean P, Chen Hsiu-Hsi T, Yen Ming-Fang A, Chen Li-Sheng S, Fann Chiang-Yuan J, Chiu, Yueh-Hsia S et al. The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. Cancer. 2018.
^viii Otto S, Fracheboud J, Verbeek A, Boer R, Reijerink-Verheij J, Otten J, Broeders M, de Koning H. Mammography Screening and Risk of Breast Cancer Death: A Population -Based Case-Control Study. American Association for Cancer Research Journals. 2012.
^ix Coldman A, Philips N, Wilson C, Decker K, Chiarelli A, Brisson J, Zhang B, Payne J, Doyle G, Rukshanda A. Pan-Canadian Study of Mammography Screening and Mortality from Breast Cancer. Journal of the National Cancer Institute. 2014.
^x Hendrick RE, Helvie M. United States Preventive Service Task Force screening mammography recommendations: science ignored. American Journal of Roentgenology. 2011.
^xi Duffy, S, Tabar L, Yen Ming-Fang A, Dean P, Smith R, et al. Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women. Cancer. 2020.
^xii Tabar L, Dean P, Chen Hsiu-Hsi T, Yen Ming-Fang A. et al. The incidence of fatal breast cancer measures the increased effectiveness of therapy in women participating in mammography screening. Cancer. 2018.
^xiii Kopans D. Arguments Against Mammography Screening Continue to be Based on Faulty Science. The Oncologist 2014: Vol. 19(2): 107–112.
^xiv Oeffinger K, Fontham E, Ruth, E et al. Breast Cancer Screening for Women at Average Risk 2014 Guideline Update from the American Cancer Society. JAMA. 2015.
^xv Kopans DB. Point: the New England Journal of Medicine article suggesting overdiagnosis from mammography screening is scientifically incorrect and should be withdrawn. J Am Coll Radiology 2013; 10:317–319.
^xvi Hendrick RE. Obligate overdiagnosis due to mammographic screening: a direct estimate for U.S. women. Radiology. 2018;287(2):391-397.
^xvii Duffy SW, Agbaje O, Tabar L, et al. Overdiagnosis and overtreatment of breast cancer: estimates of overdiagnosis from two trials of mammographic screening for breast cancer. Breast Cancer Res. 2005;7(6):258-265.
^xviii Arleo, E, Monticciolo D, Monsees B, McGinty G, Sickles E. Persistent Untreated Screening-Detected Breast Cancer: An Argument Against Delaying Screening or Increasing the Interval Between Screenings. Journal of American College of Radiology. 2017.
^xix Tosteson A, Fryback D, Hammond C et al. Consequences of False-Positive Screening Mammograms. JAMA Intern Med. 2014.
^xx Schwartz L, Woloshin S, Fowler F et al. Enthusiasm for Cancer Screening in the United States. JAMA. 2009.

SOURCE American College of Radiology