At what age can mammograms and colonoscopies or Cologuard be stopped?

When to Stop Mammograms and Colorectal Cancer Screening

For most individuals, mammograms can be discontinued after age 75 if there's a history of normal results, and colorectal cancer screening (including Cologuard) can be stopped at age 75 for those with normal prior screening results and no significant risk factors.

Mammography Screening Discontinuation

Age-Based Recommendations

• The American Cancer Society (ACS) does not specify an upper age limit for mammography screening 1
• Instead, the decision should be based on:
  • Overall health status
  • Estimated life expectancy
  • History of prior normal screenings
  • Individual risk factors

Evidence for Stopping Mammography

• Women aged 75-84 years show no substantial reduction in 8-year breast cancer mortality with continued annual screening compared to stopping 2
• 80% of the mortality benefit from mammography is achieved before age 75 3
• The small potential benefit (estimated at 5 days of life expectancy gained) for continuing mammography beyond age 80 may be outweighed by harms including:
  • Anxiety
  • Additional testing
  • Unnecessary treatment

Algorithm for Mammography Discontinuation

1. Stop at age 75 if:

   • No history of high-risk factors (BRCA mutation, strong family history)
   • Normal mammograms in the past 10 years
   • Life expectancy less than 10 years

2. Consider continuing beyond age 75 only if:

   • Patient has excellent health status
   • Life expectancy exceeds 10 years
   • Patient has high-risk factors for breast cancer

Colorectal Cancer Screening Discontinuation

Age-Based Recommendations

• ACS recommends regular colorectal cancer screening until age 75 4
• After age 75, screening should be discontinued for most individuals

Evidence for Stopping Colorectal Cancer Screening

• 80% of the mortality benefit from colorectal cancer screening is achieved by age 80 3
• The small potential benefit (estimated at 5 days of life expectancy gained) for continuing screening beyond age 80 may be outweighed by risks including:
  • Procedural complications
  • False positives leading to unnecessary procedures
  • Discomfort and preparation burden

Algorithm for Colorectal Cancer Screening Discontinuation

1. Stop at age 75 if:

   • No history of colorectal polyps or cancer
   • Normal screening results in the past 10 years
   • Life expectancy less than 10 years

2. Consider continuing until age 80 only if:

   • Patient has excellent health status
   • History of adenomatous polyps
   • Family history of colorectal cancer
   • Life expectancy exceeds 10 years

Common Pitfalls in Cancer Screening for Older Adults

Over-screening

• Studies show many patients continue screening well beyond recommended ages 5
• Median years of screening past guideline-based recommendations: 5 years for breast cancer and 4 years for colorectal cancer 5
• Over-screening can lead to unnecessary procedures, anxiety, and complications with minimal mortality benefit

Under-consideration of Comorbidities

• Screening decisions should incorporate comorbidity burden, not just age
• Patients with ≥3 comorbidities have diminished life expectancy and reduced potential benefit from screening 5

Lack of Shared Decision-Making

• Many patients are not adequately informed about the diminishing returns of continued screening with advancing age
• Discussions should include both potential benefits (earlier detection) and harms (false positives, complications from follow-up procedures)

Key Takeaway

When determining when to stop cancer screening, focus on the individual's overall health status, prior screening history, and estimated life expectancy rather than age alone. For most average-risk individuals with normal prior screening results, mammography and colorectal cancer screening (including Cologuard) can be discontinued at age 75 with minimal impact on mortality outcomes.