At what age should a woman stop getting a mammogram (mammography) screening?

When to Stop Mammography Screening

Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer, rather than stopping at a specific age. 1

Guidelines for Mammography Discontinuation

The decision to stop mammography screening should be based on several factors, not just chronological age:

Life Expectancy Considerations

• Continue screening if life expectancy is ≥10 years 1
• Discontinue screening if life expectancy is <10 years 1

Health Status Assessment

• Good health: Continue screening regardless of age
• Poor health with multiple comorbidities: Consider discontinuing screening
• Severe functional limitations: Consider discontinuing screening

Decision-Making Process

1. Assess overall health status and comorbidities
2. Estimate life expectancy (based on health status, not just age)
3. Discuss benefits and harms with patient
4. Make shared decision based on patient values and preferences

Evidence Supporting These Recommendations

The American Cancer Society (ACS) guidelines clearly state that women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer 1. This is a qualified recommendation that emphasizes health status over chronological age.

The American College of Physicians (ACP) guidance similarly states that "age alone should not be the basis to continue or discontinue screening" and that "beyond age 75 years, the decision to discontinue screening mammography should be based on a shared decision making process informed by the woman's health status and longevity" 1.

Benefits vs. Harms in Older Women

Potential Benefits

• Early detection of breast cancer
• Reduced breast cancer mortality (studies show approximately two-fold higher risk of disease-specific mortality among women who did not perform screening mammography compared to women who did) 2
• Earlier stage at diagnosis 2

Potential Harms

• False positive results leading to unnecessary anxiety and procedures
• Overdiagnosis of indolent cancers
• Discomfort during the procedure
• The benefit of screening diminishes with age (80% of the benefit is achieved before 75 years of age for breast cancer) 3

Common Pitfalls in Decision-Making

1. Setting arbitrary age cutoffs: Many providers incorrectly use age 75 as a strict cutoff, but guidelines emphasize health status and life expectancy instead 1

2. Failure to discuss cessation: Research shows that discussions around screening cessation are rare - only 5% of women who stopped screening reported a recommendation to stop from their doctor 4

3. Continuing screening by habit: "Habit" is one of the top factors influencing older women to continue screening, rather than evidence-based decision-making 5

4. Not considering patient preferences: Most older women prefer to make the final decision about mammography screening on their own 5

Algorithm for Deciding When to Stop Mammography

1. Assess health status:

   • Review medical conditions and functional status
   • Estimate 10-year life expectancy

2. If life expectancy ≥10 years and good health:

   • Continue mammography screening regardless of age

3. If life expectancy <10 years OR poor health:

   • Discuss limited benefit of continued screening
   • Consider discontinuing mammography

4. Document discussion and decision in medical record

By focusing on health status and life expectancy rather than age alone, clinicians can make more appropriate recommendations about when to stop mammography screening for individual women.