Who to Believe: Making Sense of Breast Cancer Screening Guidelines

By Nicole Choy · Apr 2019

In April 2019, the American College of Physicians (ACP) released new guidance statements for mammogram screenings for average-risk women. Different major organizations have reached different conclusions about the optimal screening schedule — and this article tries to make sense of why.

What the ACP Recommends

After reviewing guidelines from ACR, ACS, USPSTF, WHO, CTFPHC, NCCN, and ACOG, the ACP concluded: for average-risk women ages 40–49, discuss the harms and benefits of screening (the ACP finds harms outweigh benefits in most women in this group); for average-risk women ages 50–74, offer biennial mammography; discontinue screening for women over 75 or with life expectancy of 10 years or less; and avoid clinical breast exams for screening in average-risk women.

Why Guidelines Disagree

The American College of Radiology challenged the ACP guidance, arguing that restricting mammograms to women 50–74 every other year could lead to thousands of additional preventable deaths annually, and that the guidance understates benefits while overstating harms. These differences reflect genuine disagreements in how to weigh evidence on age-specific risks and benefits — not simply political disagreement. The best approach for any patient is a conversation with their doctor about the schedule that makes sense for their specific situation and risk factors.