At what age should breast cancer screening be stopped?

When to Stop Breast Cancer Screening

Breast cancer screening should be discontinued in average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, regardless of age. 1

Age-Based Recommendations for Stopping Screening

• Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more 1
• For women aged 75 years and older, the decision to discontinue screening should incorporate:
  • Risk for cancer death
  • Competing risks for other causes of death
  • The long time lag between mammography and reduction in breast cancer mortality (approximately 11 years before 1 death from breast cancer is prevented per 1000 women screened) 1
  • Individual patient's values and preferences 1

Life Expectancy Considerations

• Among 70-year-old women with no comorbid conditions, average life expectancy is approximately 19 years 1
• Among 75-year-old women with no comorbid conditions, average life expectancy is approximately 15 years 1
• Among 70-year-old women with serious comorbid conditions, average life expectancy is approximately 11 years 1
• Among 75-year-old women with serious comorbid conditions, average life expectancy is approximately 9 years 1

Comorbidity Assessment

• Screening should be discontinued in women with significant comorbidities that limit life expectancy, such as:
  • Chronic obstructive pulmonary disease
  • Heart failure
  • End-stage liver disease
  • End-stage renal failure
  • Dementia 1

Balancing Benefits and Harms in Older Women

• Older women face a higher probability of developing and dying from breast cancer but also have a greater chance of dying from other causes 1
• Potential harms of continued screening in older women include:
  • False-positive results leading to unnecessary anxiety
  • Additional imaging studies
  • Unnecessary biopsies
  • Overdiagnosis of indolent disease that would never become clinically significant 1
  • Overtreatment 1

Decision-Making Framework

1. Assess the woman's overall health status and comorbidities
2. Estimate life expectancy based on age and comorbidities
3. If life expectancy is less than 10 years, discontinue screening 1
4. If life expectancy is greater than 10 years, continue screening with biennial mammography 1

Common Pitfalls to Avoid

• Using age alone as the sole criterion to discontinue screening without considering overall health status 1
• Continuing screening in women with significant comorbidities who are unlikely to benefit due to limited life expectancy 1
• Failing to engage in shared decision-making about the benefits and harms of continued screening in older women 1
• Not considering the time lag between screening and mortality benefit (approximately 11 years) when making decisions about stopping screening 1

Special Considerations

• For women with a family history of breast cancer, the same principles apply regarding when to stop screening - the 10-year life expectancy threshold remains the key factor 2, 3
• Digital breast tomosynthesis (DBT) may be used instead of standard mammography for women who continue screening, as it decreases recall rates and improves cancer detection 2