From the Guidelines
Women are generally recommended to continue mammograms until age 74, after which the decision becomes more individualized, based on the most recent evidence from 1 and 1. The standard recommendation is for women of average risk to begin mammogram screening at age 40 and continue through age 74 with screenings every 1-2 years. After age 74, the benefits of mammography may decrease as life expectancy shortens and the potential harms (such as false positives, unnecessary biopsies, and overdiagnosis) may outweigh the benefits for some women. However, women who are in good health with a life expectancy of 10 or more years may choose to continue screening beyond age 74 after discussing with their healthcare provider. The recommendation to stop at age 74 is based on the diminishing benefit of detecting slow-growing cancers in older women and the increased likelihood that other health conditions may be more pressing concerns. Women should consider their overall health status, personal preferences, and family history when making decisions about when to stop mammogram screening.
Some key points to consider:
- The American College of Radiology recommends annual screening mammography beginning no later than 40 years of age for women at intermediate risk 1.
- Women should continue screening mammography as long as they remain in overall good health and are willing to undergo the examination and subsequent testing or biopsy, if an abnormality is identified 1.
- For those with a family history of breast cancer, mammography should begin earlier if familial breast cancer occurred at a young age, typically 10 years prior to the youngest age at presentation but generally not before 30 years of age 1.
- Early detection of second breast cancers improves survival, so patients with a personal history of breast cancer should undergo annual mammography or DBT for surveillance following breast conservation therapy 1.
It's essential to weigh the benefits and risks of mammography screening, considering individual factors such as life expectancy, overall health, and personal preferences, as recommended by 1 and 1.
From the Research
Mammography Screening Recommendations
- The American College of Radiology (ACR) and Society of Breast Imaging recommend annual mammography screening beginning at age 40, which provides the greatest mortality reduction, diagnosis at earlier stage, better surgical options, and more effective chemotherapy 2.
- Screening should continue past age 74 years, without an upper age limit unless severe comorbidities limit life expectancy 2.
- For women aged 75 years and older, guidelines recommend individualizing screening mammography decisions, taking into account life expectancy and comorbidities 3, 4.
Benefits and Risks of Screening
- Mammography screening has been proven effective in reducing breast cancer deaths in women age 40 years and older, with a mortality reduction of 40% possible with regular screening 2.
- The benefits of screening should be considered along with the possibilities of recall for additional imaging and benign biopsy, as well as the less tangible risks of anxiety and overdiagnosis 2, 3.
- Potential harms of continued screening over 10 years include false-positive mammograms and overdiagnosis 3.
Screening Strategies for Specific Populations
- For women with a life expectancy of more than 10 years, deciding whether potential benefits of screening outweigh harms becomes a value judgment for patients, requiring a realistic understanding of screening outcomes 3.
- For BRCA1 and BRCA2 gene mutation carriers, annual screening strategies with mammography and magnetic resonance imaging (MRI) are recommended, starting at ages 25-30 years 5.
- The USPSTF recommends that the decision to start regular, biennial screening mammography for females younger than 50 years should be an individual decision, taking patient context into account, including patient values regarding specific benefits and harms 6.