NCCN Guidelines Update Recommends Breast Cancer Screening at Age 35 for High-Risk Women Identified by AI
In an update to the National Comprehensive Cancer Network (NCCN) Breast Cancer Screening and Diagnosis Guidelines (v1.2026), screening is now recommended to begin as early as age 35 for individuals at increased risk of invasive breast cancer. Earlier screening—prior to the U.S. Preventive Services Task Force (USPSTF) recommended starting age of 40—is advised for those with a 5-year invasive breast cancer risk of 1.7% or higher as determined by validated risk assessment tools, including the modified Gail model and AI-based risk models.
The NCCN Panel also recommends annual digital mammography with tomosynthesis and clinical evaluation every 6 to 12 months, with consideration of annual breast MRI with or without contrast. Periodic risk reassessment is advised as risk factors evolve, along with counseling on risk-reduction strategies.
The guidelines note that AI-based risk assessment models are effective tools for estimating an individual’s risk of invasive breast cancer. In a systemic review of AI-driven risk prediction studies, image-based AI models outperformed traditional approaches, with a higher median area under the curve (AUC = 0.72) compared with breast density models and clinical risk prediction tools such as the Gail and Tyrer-Cuzick models (AUC = 0.61). Models incorporating both imaging and clinical risk factors achieved a median AUC of 0.73.
In a press release, Clairity, Inc.—developer of Clairity Breast, the first FDA-approved AI model for predicting 5-year breast cancer risk from mammography—highlighted the impact of these updates. Beth Mittendorf, MD, PhD, Chief of Breast Surgery, Beth Israel Deaconess Medical Center and Professor of Surgery, Harvard Medical School, stated in the release, “This is a meaningful evolution in how we think about breast cancer risk. Incorporating this approach into national guidelines expands our ability to identify women who may otherwise not be recognized as being at increased risk, creating new opportunities for more personalized screening and prevention strategies.”
“This provides an opportunity to translate these advances into clinical practice in a way that ensures women truly benefit,” added Tari King, MD, Chief of Breast Surgery, Emory University School of Medicine and Surgical Director, Glenn Family Breast Center Winship Cancer Institute. “That means making risk assessment accessible, understandable, and actionable across care settings so that more women can receive care tailored to their individual risk.”
ASCO AI in Oncology is published by Conexiant under a license arrangement with the American Society of Clinical Oncology, Inc. (ASCO®). The ideas and opinions expressed in ASCO AI in Oncology do not necessarily reflect those of Conexiant or ASCO. For more information, see Policies.