Until what age should routine mammography be performed in average‑risk women?

Mammography Screening: Upper Age Limit

There is no specific upper age limit for stopping mammography screening—women should continue annual screening mammography as long as they remain in overall good health with a life expectancy of at least 10 years and are willing to undergo subsequent testing or biopsy if abnormalities are found. 1

Evidence-Based Approach to Screening Beyond Age 75

The most recent ACR guidelines (2025) emphasize that screening decisions should be based on life expectancy and competing comorbidities rather than age alone 1. This represents the consensus across major guideline organizations, as randomized controlled trials did not enroll women over age 74, yet observational studies demonstrate continued benefit in women ≥75 years 1.

Key Decision Factors:

• Overall health status: Women must be in good general health to benefit from screening
• Life expectancy ≥10 years: Mortality reduction from screening requires years to be fully realized 1
• Willingness to undergo follow-up: Patient must be willing to undergo additional testing or biopsy if abnormalities are detected 1
• Competing comorbidities: Use mortality indices incorporating age, comorbidities, and functional status 2

Practical Clinical Algorithm:

For women age 75 and older:

1. Assess life expectancy using validated mortality indices that incorporate:

   • Chronological age
   • Comorbid conditions
   • Functional status 2

2. If life expectancy ≥10 years AND good overall health:

   • Continue annual screening mammography 1
   • Maintain same screening protocol as younger women

3. If life expectancy <10 years OR significant comorbidities:

   • Discontinue routine screening
   • Engage in shared decision-making about risks/benefits

Important Caveats:

The American Cancer Society recommends continuing screening "as long as their overall health is good and they have a life expectancy of 10 years or longer" 2. This qualified recommendation acknowledges uncertainty about the balance of benefits and harms in older women, requiring individualized assessment.

Critical pitfall to avoid: Do not use age 75 as an automatic cutoff. Some healthy 80-year-olds benefit from continued screening, while some 70-year-olds with multiple comorbidities do not 1. The decision must incorporate functional status and competing mortality risks, not chronological age alone.

The ACR's 2025 update reinforces that observational studies show benefit in women ≥75 years who meet health criteria, though no upper age limit has been established by consensus 1.