At what age can women stop having routine mammogram (mammography) screenings?

When to Stop Mammogram Screening for Breast Cancer

Women should discontinue screening mammography when they have a life expectancy of less than 10 years, typically around age 75 or older, or when they have significant comorbid conditions that limit life expectancy. 1

Age-Based Recommendations for Discontinuing Mammography

• Most guidelines recommend discontinuing screening mammography when a woman's life expectancy is less than 10 years, as the benefits of screening take approximately 11 years to manifest 1
• The U.S. Preventive Services Task Force (USPSTF) concludes there is insufficient evidence to assess the balance of benefits and harms of screening mammography in women 75 years or older 1, 2
• The American Cancer Society recommends that women continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more 1
• The American College of Physicians explicitly recommends discontinuing screening for breast cancer in average-risk women aged 75 years or older 1

Life Expectancy Considerations

• Among women aged 70 years with no comorbid conditions, life expectancy is approximately 19 years, while those with serious comorbid conditions have a life expectancy of approximately 11 years 1
• For women aged 75 years with no comorbid conditions, life expectancy is approximately 15 years, while those with serious comorbid conditions have a life expectancy of approximately 9 years 1
• Moderate comorbid conditions that may impact life expectancy include cardiovascular disease, paralysis, and diabetes 1
• Severe comorbid conditions that significantly reduce life expectancy include AIDS, chronic obstructive pulmonary disease, liver disease, chronic renal failure, dementia, congestive heart failure, and combinations of moderate comorbid conditions 1

Benefits and Harms of Continuing Screening in Older Women

Benefits:

• CISNET models suggest that biennial mammography screening may potentially continue to offer a net benefit after age 74 years among those with no or low comorbidity 1
• Observational studies favor extending screening mammography to older women who have a life expectancy of more than 10 years 3
• Modeling studies estimate 2 fewer breast cancer deaths per 1,000 women in their 70s who continue biennial screening for 10 years 3

Harms:

• Potential harms of continued screening over 10 years include false-positive mammograms in approximately 200 per 1,000 women screened 3
• Overdiagnosis (finding breast cancer that would not have clinically surfaced otherwise) occurs in approximately 13 per 1,000 women screened over 10 years 3
• Unnecessary biopsies, anxiety, and overtreatment are additional potential harms 1

Decision-Making Algorithm for Older Women

1. Assess life expectancy:

   • Consider age, comorbidities, and functional status 1
   • Use validated mortality indices that incorporate these factors 1

2. If life expectancy is greater than 10 years:

   • Continue biennial mammography screening 1
   • Consider patient preferences and values regarding potential benefits and harms 3

3. If life expectancy is less than 10 years:

   • Discontinue mammography screening 1
   • Focus on other health promotion measures with more immediate benefits 3

4. For women with severe comorbidities regardless of age:

   • Discontinue mammography screening if comorbidities significantly limit life expectancy 1

Special Considerations

• For women who have been regularly screened, the decision to stop should incorporate risk for cancer death, competing risks for other causes of death, and the individual's values and preferences 1
• The long time lag (approximately 11 years) between mammography and reduction in breast cancer mortality should be considered when making decisions about stopping screening 1, 3
• Women with limited life expectancy due to comorbid conditions (such as chronic obstructive pulmonary disease, heart failure, end-stage liver disease, end-stage renal failure, or dementia) should discontinue screening regardless of age 1

Common Pitfalls in Decision-Making

• Using chronological age alone rather than life expectancy to determine when to stop screening 1, 3
• Continuing screening in women with severe comorbidities who are unlikely to benefit 1
• Failing to consider patient preferences and values in the decision-making process 1, 3
• Not recognizing that the benefits of screening take years to manifest, while the harms are immediate 1, 3