At what age can I stop getting colonoscopy (colon cancer screening), Pap (Pap smear) smears, and mammograms (breast cancer screening)?

Age Recommendations for Stopping Cancer Screening

For most adults, colorectal cancer screening should stop at age 75 for those with adequate prior screening history and negative results, or when life expectancy is less than 10 years. Pap smears can be discontinued at age 65 with adequate negative prior screening, and mammograms should generally be stopped at age 75.

Colorectal Cancer Screening

When to Stop Screening

• For individuals with adequate prior screening and negative results:

  • Stop at age 75 1, 2
  • Consider stopping earlier when life expectancy is less than 10 years 1, 2

• For individuals without prior adequate screening:

  • Consider screening up to age 85, depending on health status and comorbidities 1
  • Screening is not recommended after age 85 for anyone 2, 3

Factors to Consider When Deciding to Stop Screening

• Comorbidity level affects stopping age:

  • No comorbidities: Consider screening up to age 83-86 4
  • Moderate comorbidities: Consider screening up to age 80-83 4
  • Severe comorbidities: Consider screening up to age 77-80 4

• Prior screening history:

  • Individuals with previous negative colonoscopy have lower risk and less benefit from additional screening after age 75 5
  • The benefit of screening diminishes significantly in those over 75 who have had adequate prior screening 6

Screening Modality Considerations for Older Adults

• For those 76-85 who still need screening:

  • Ages 76-80: Colonoscopy may still be appropriate 4
  • Ages 81-83: Consider less invasive options like sigmoidoscopy 4
  • Ages 84-86: FIT testing may be most appropriate 4

• Risk-benefit assessment:

  • The absolute risk reduction for CRC in those 75-79 years is only 0.14% compared to 0.42% in those 70-74 years 6
  • Adverse events from colonoscopy nearly double from 5.6 per 1000 in ages 70-74 to 10.3 per 1000 in ages 75-79 6

Cervical Cancer Screening (Pap Smears)

• Stop cervical cancer screening at age 65 for women with:
  • Adequate prior screening history (at least 3 consecutive negative cytology results or 2 consecutive negative co-testing results within the past 10 years)
  • No history of CIN2+ within the past 25 years
  • No history of cervical cancer

Breast Cancer Screening (Mammograms)

• Stop routine mammography screening at age 75
• For women aged 75 and older, the potential harms of screening mammography (false positives, overdiagnosis, overtreatment) may outweigh the benefits due to competing mortality risks

Key Considerations for All Screening Decisions

• Life expectancy is crucial:

  • A minimum of 10 years life expectancy is generally needed to benefit from cancer screening
  • Screening should be discontinued when life expectancy is less than 10 years

• Risk-benefit assessment:

  • The benefit of screening diminishes with age while risks increase
  • Screening-related harms include complications from procedures, anxiety from false positives, and overdiagnosis

• Prior screening history:

  • Those with negative prior screening results have lower risk and may safely discontinue screening earlier
  • Those without adequate prior screening may benefit from screening at older ages (up to 85 for colorectal cancer)

• Health status:

  • Healthier individuals with longer life expectancy may benefit from continued screening
  • Those with significant comorbidities should consider earlier cessation of screening

Remember that these recommendations apply to average-risk individuals. Those with specific risk factors (family history, genetic syndromes, etc.) may require different screening approaches.