The recent update from the American College of Physicians has reignited debate over when and how often women should undergo breast cancer screening.

The new guidelines, published in the Annals of Internal Medicine, recommend that women between the ages of 50 and 74 at average risk and without symptoms receive mammograms every two years.

For women between 40 and 49, the organization urges them to consult their doctors to weigh both the potential benefits and harms of screening. The ACP warned that unnecessary testing can lead to false positives, psychological distress, over-diagnosis, and exposure to radiation.

In contrast, many women have traditionally been advised to begin annual mammograms at 40. The updated ACP approach shifts emphasis toward individualized decisions and reduced screening frequency. The group said women 75 and older who are asymptomatic and at average risk should consider stopping screenings after discussing it with their healthcare providers.

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The ACP explained that benefits after age 74 are uncertain, while risks of over-diagnosis and unnecessary treatment increase. For women with dense breast tissue, the ACP supports using digital breast tomosynthesis, also called 3D mammography.

The organization cautioned against supplemental MRI or ultrasound screening in this population, citing concerns about additional testing, cost, and exposure. “Decisions should consider potential benefits and harms, radiation exposure, availability, patient values and preferences, and cost,” the group wrote.

Dr. Jason M. Goldman, president of the ACP, noted that screening remains vital but should be evidence-based. “ACP developed this guidance to provide physicians and females with the information they need to make breast cancer screening decisions, including when to start and discontinue, how often to screen and which methods to use for screening,” he said.

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However, not all experts agree with the new approach. Dr. Lauren Carcas, a medical oncologist at the Miami Cancer Institute, said the guidance “adds to the confusion of screening recommendations.” She argued that the plan assumes all women have equal access to individualized risk discussions, which is not always the case.

Carcas suggested that biennial screenings might increase disparities and delay diagnosis, particularly in communities already facing barriers to care. She pointed out that other medical groups, including the American College of Radiology and the American Society of Breast Surgeons, continue to support annual screening beginning at age 40.

The divide, she said, centers largely on screening intervals. “All major U.S. societies agree that mammography screening should be available starting at age 40,” Carcas said. “However, by age 25, all women should undergo a formal breast cancer risk assessment in order to direct their ongoing screening.”

Carcas also disagreed with ACP’s recommendation against MRI or ultrasound for dense breast tissue, noting that radiologic societies “very strongly recommend” these additional imaging tools for more complete results.

Women with a 20% or higher lifetime risk of developing breast cancer, she added, should receive annual screening with supplemental imaging as appropriate.

For women at average risk, Carcas said decisions should reflect discussions between patients and their physicians. Depending on preferences and medical advice, women could choose annual or biennial mammograms under a shared decision-making process.

She also pointed to a “gap in evidence” comparing mortality outcomes of annual versus biennial screening, as no randomized trial has yet established a clear difference. “Most women who are diagnosed with breast cancer would certainly be grateful to have it diagnosed at an earlier stage,” she said.

Despite differing perspectives, Carcas said she intends to continue recommending annual screening for her patients. She added that she hopes the new guidance will not affect insurance coverage for those seeking earlier or more frequent mammograms.

The debate reflects a long-running tension in women’s health guidelines, where organizations balance evidence on benefits, risks, and access. As differing expert opinions continue to circulate, many women may find themselves turning to their healthcare providers for individualized advice.