Key Insights on Mammography Research, Breast MRI Studies and Breast Cancer Screening Guidelines

There was an array of newsworthy developments in breast imaging in April 2026 with emerging research insights on AI and digital breast tomosynthesis (DBT) as well as provocative breast MRI research on the impact of background parenchymal enhancement (BPE) and neoadjuvant chemotherapy (NAC). Breast cancer screening guidelines were also in the news with new updates from the National Comprehensive Cancer Network (NCCN) and a controversial guidance from the American College of Physicians (ACP).

Emerging Insights on AI in Screening Mammography and DBT

A prospective paired non-inferiority trial published in Nature Medicine examined the effect of a partially autonomous AI-supported screening strategy on radiologist workload and cancer detection in approximately 31,000 women in Spain undergoing screening with digital mammography or DBT.¹

The AI system assigned a risk score (1–10) to each examination. Roughly 70 percent of cases scored as low risk (1–7) were automatically classified as normal without radiologist review while the remaining high-risk cases underwent double reading with AI support.¹

In the AI-supported arm, radiologist workload was 63.6 percent lower, and the cancer detection rate was 15.2 percent higher (7.3 vs 6.3 per 1,000 examinations), though the recall rate was also higher by 14.8 percent.^1,2 Manisha Bahl, MD, discussed the study's implications in an episode of her Breast Imaging in Focus series, noting both the promise and limitations of partially autonomous AI workflows.²

In research presented at the Society of Breast Imaging (SBI) Symposium, a study involving more than 300 women demonstrated that AI software identified breast cancer missed by radiologists on one prior screening DBT exam in 26.8 percent of patients and on three prior screening DBT exams in 11 percent of patients.^3,4 These findings raise the possibility that AI may have the capacity to flag cancers years before they are detected with standard interpretation.

In other news from the SBI symposium, Lunit announced FDA 510(k) clearance of version 1.2 of its Lunit INSIGHT DBT algorithm at the SBI Annual Symposium. The updated version offers current-prior comparison of up to two prior studies, multiple selectable operating thresholds to balance sensitivity and specificity, and integration of volumetric breast density data alongside AI findings.^5,6

Breast Cancer Screening Guideline Updates and Controversies

The NCCN issued updated breast cancer screening and diagnosis guidelines that include AI-powered five-year risk assessment beginning at age 35, using Clairity Breast software.⁷

In an interview with Diagnostic Imaging, Connie Lehman, MD, PhD, noted that previous NCCN recommendations placed heavy emphasis on lifetime risk models dependent on family history or genetic mutations. By acknowledging that younger women represent the fastest growing group of women being diagnosed with breast cancer, Dr. Lehman said the updated NCCN guidelines may potentially enable more dynamic, personalized risk stratification.⁸

The ACP released a breast cancer screening guidance for asymptomatic, average-risk women recommending biennial mammography for women in their 40s after shared decision-making with a physician and biennial mammography for women aged 50–74.⁹ The ACP guidance also recommended against the use of supplemental MRI or ultrasound in women with BI-RADS C or D breast density.⁹

The American College of Radiology (ACR) and SBI responded with a joint statement warning that the ACP recommendations conflict with guidelines from nearly every major cancer organization, and that screening only women aged 50–74 biennially could result in up to 10,000 additional breast cancer deaths per year in the United States.¹⁰ Several breast radiologists — including Wendie Berg, MD, PhD, Stamatia Destounis, MD, and Dr. Bahl — described the guidance as representing “many steps backward” from established breast cancer screening recommendations from organizations such as the ACR a.¹¹

What New Breast MRI Research Reveals

In contrast to a 2025 meta-analysis finding greater than 10 percent reductions in sensitivity and specificity with moderate or marked background parenchymal enhancement (BPE) on breast MRI, new research published in European Radiology suggested the BPE has no impact on cancer detection with breast MRI.^12,13

In the retrospective study involving 282 breast lesions with biopsy results, researchers found no statistically significant differences in AUC, sensitivity nor specificity for breast cancer detection between women who had minimum/mild BPE and those who had moderate/marked BPE.¹³

A study published in Academic Radiology evaluated pre- and post-NAC cardiac and brain MRI parameters in 85 breast cancer patients — 18 with cancer therapy-related cardiac dysfunction (CTRCD) and 67 without — and assessed the relationship to cognitive function. The findings suggested that NAC-associated cardiotoxicity and neurotoxicity may be interrelated rather than independent processes, supporting an integrated approach to monitoring in this patient population.^14,15

Social Risk Factors and Breast Cancer Screening Equity

Research presented at the SBI Symposium examined the relationship between social risk factors and completion of follow-up diagnostic imaging after an abnormal screening mammogram.^16,17 This work adds to a growing body of evidence indicating that social determinants of health — including food insecurity, transportation barriers, and housing instability — are associated with reduced mammography utilization and delayed diagnostic follow-up, with implications for early breast cancer detection across populations.

Can A Breast Radiologist Become U.S. Surgeon General?

On April 30, 2026, President Trump nominated Nicole Saphier, MD, a breast radiologist and associate professor of radiology at Weill Cornell Medical College and Memorial Sloan Kettering Cancer Center (MSKCC), to serve as U.S. Surgeon General.^18,19 Amy Patel, MD, said Dr. Saphier is “a fierce advocate for patient care and access” and a “hard-working steward” for radiology.¹⁹

References

1. Elias-Cabot E, Romero-Martin S, Raya-Povedano JL, Rodriguez-Ruiz A, Alvarez-Benito M. AI-based triage and decision support in mammography and digital tomosynthesis for breast cancer screening: a paired, noninferiority trial. Nat Med. 2026 Mar 19. doi: 10.1038/s41591-026-04277-x. Online ahead of print.

2. Bahl M. Breast Imaging in Focus: Can partially autonomous AI-supported screening have an impact with mammography and DBT? Diagnostic Imaging. Available at: https://www.diagnosticimaging.com/view/breast-imaging-focus-partially-autonomous-ai-supported-screening-mammography-dbt- . Published April 13, 2026. Accessed April 30, 2026.

3. Lamb LR. Artificial intelligence for earlier detection of breast cancer on screening digital breast tomosynthesis. Presented at the Society of Breast Imaging Symposium, April 16-19, 2026, Seattle. https://2026-sbi-symposium.eventscribe.net/

4. Can AI detect breast cancer on DBT years earlier than radiologists? Diagnostic Imaging. Available at: https://www.diagnosticimaging.com/view/can-ai-detect-breast-cancer-dbt-years-earlier-than-radiologists- . Published April 24, 2026. Accessed April 30, 2026.

5. FDA clears updated version of 3D mammography algorithm from Lunit. Diagnostic Imaging. Available at: https://www.diagnosticimaging.com/view/fda-clears-updated-version-3d-mammography-algorithm-lunit . Published April 18, 2026. Accessed April 30, 2026.

6. Lunit. Lunit surpasses 330+ sites and 1M annual screenings as breast imaging AI moves into clinical practice. April 16, 2026. Available at: https://www.prnewswire.com/news-releases/lunit-surpasses-330-sites-and-1m-annual-screenings-as-breast-imaging-ai-moves-into-clinical-practice-302744532.html . Published April 16, 2026. Accessed April 30, 2026.

7. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Breast Cancer Screening and Diagnosis. Version 2.2025—March 28, 2025. Available at: https://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf . Accessed April 30, 2026.

8. Hall J. A closer look at the latest updates to the NCCN guidelines on breast cancer screening. Diagnostic Imaging. Available at: https://www.diagnosticimaging.com/view/closer-look-latest-updates-nccn-guidelines-breast-cancer-screening . Published April 16, 2026. Accessed April 30, 2026.

9. Qaseem A, Harrod CS, Balk EM, et al. Screening for breast cancer in asymptomatic, average-risk adult females: a guidance statement from the American College of Physicians (version 2). Ann Intern Med. 2026 Apr 17. doi: 10.7326/ANNALS-25-05116. Online ahead of print.

10. American College of Radiology and Society of Breast Imaging. New ACP Breast Cancer Screening Guidelines Are a Step Backward that May Cost Lives. PRNewswire. April 17, 2026. Available at: https://www.prnewswire.com/news-releases/new-acp-breast-cancer-screening-guidelines-are-a-step-backward-that-may-cost-lives-302746220.html . Published April 17, 2026. Accessed April 30, 2026.

11. Hall J. Breast radiologists say new ACP breast cancer screening guidelines are 'many steps backward' and 'dangerous.' Diagnostic Imaging. Available at: https://www.diagnosticimaging.com/view/breast-radiologists-new-acp-breast-cancer-screening-guidelines-many-steps-backward-dangerous- . Published April 27, 2026. Accessed April 30, 2026.

12. Bechyna S, Baltzer PAT. Impact of background parenchymal enhancement on diagnostic performance of breast MRI: a systematic review and meta-analysis. Radiology. 2025;315(2):e241919. doi: 10.1148/radiol.241919.

13. Hall J. New breast MRI study says background parenchymal enhancement has no impact on lesion detection. Diagnostic Imaging. Available at: https://www.diagnosticimaging.com/view/breast-mri-study-background-parenchymal-enhancement-no-impact-lesion-detection . Published April 6, 2026. Accessed April 30, 2026.

14. Luo X, Liu D, Tan Y. MRI characteristics of cardiotoxicity and neurotoxicity in patients with breast cancer treated with neoadjuvant chemotherapy: dynamic changes and interrelationships. Acad Radiol. 2026 Apr 7:S1076-6332(26)00190-X. doi: 10.1016/j.acra.2026.03.024. Online ahead of print.

15. Hall J. MRI study reveals potentially severe impact of NAC on heart and brain function in breast cancer patients. Diagnostic Imaging. 2026. Available at: https://www.diagnosticimaging.com/view/mri-study-potentially-severe-impact-nac-heart-brain-function-breast-cancer-patients . Published April 7, 2026. Accessed April 30, 2026.

16. Miles BL. Social risk and completion of diagnostic workup after abnormal screening mammography: a global, multicenter cohort. Presented at the Society of Breast Imaging (SBI) Symposium, April 16-19, 2026, Seattle. Available at: https://2026-sbi-symposium.eventscribe.net/ .

17. Hall J. SBI: What a new study reveals about social risk factors and follow-up imaging after abnormal screening mammograms. Diagnostic Imaging. 2026. Available at: https://www.diagnosticimaging.com/view/sbi-new-study-social-risk-factors-follow-up-imaging-abnormal-screening-mammograms . Published April 17, 2026. Accessed April 30, 2026.

18. Trump nominates breast radiologist Nicole Saphier as Surgeon General. The Hill. Available at: https://thehill.com/policy/healthcare/5857814-nicole-saphier-surgeon-general-nominee/ . Published April 30, 2026. Accessed April 30, 2026.

19. Hall J. Breast radiologist nominated for Surgeon General by President Trump. Diagnostic Imaging. 2026. Available at: https://www.diagnosticimaging.com/view/breast-radiologist-nominated-surgeon-general-president-trump . Published April 30, 2026. Accessed April 30, 2026.