At what age can I stop getting mammography (mammogram) screenings?

When to Stop Mammography Screening

Women should continue mammography screening until at least age 75 years, and beyond age 75 if they remain in good health with a life expectancy of 10 years or more. 1, 2, 3

Age-Based Stopping Criteria

Age 75 and Beyond

• The American College of Physicians recommends discontinuing screening mammography in average-risk women aged 75 years or older, though this should be based on overall health status rather than age alone 1, 2, 3
• Women aged 75+ with good health and life expectancy ≥10 years should continue screening, as more than one-third of all breast cancer deaths occur in women diagnosed after age 70 1, 4
• The American Cancer Society and American College of Radiology state there is no absolute upper age limit for stopping mammography screening 1, 4

Life Expectancy as the Primary Determinant

The decision to stop screening should be based on a 10-year life expectancy threshold, not chronological age alone. 1, 2, 3

• It takes approximately 11 years before 1 death from breast cancer is prevented for every 1,000 women screened, meaning women with <10 years life expectancy are unlikely to benefit 2
• Among 75-year-old women with no comorbid conditions, average life expectancy is approximately 15 years 2, 3
• Among 75-year-old women with serious comorbid conditions, average life expectancy drops to approximately 9 years 2, 3

Clinical Algorithm for Stopping Screening

Step 1: Assess Age

• If patient is <75 years old → Continue screening 1, 2
• If patient is ≥75 years old → Proceed to Step 2 2, 3

Step 2: Evaluate Comorbidities and Life Expectancy

• Assess for serious conditions: end-stage renal disease, severe heart failure (NYHA Class III-IV), dementia, metastatic cancer, chronic obstructive pulmonary disease requiring oxygen, end-stage liver disease 2, 3
• If life expectancy is ≥10 years → Continue screening 1, 2, 3
• If life expectancy is <10 years → Discontinue screening 2, 3

Step 3: Consider Patient Preferences

• Discuss that continued screening requires willingness to undergo additional testing and potential biopsy if abnormalities are found 1
• Explain that harms (false positives, overdiagnosis, unnecessary biopsies) may outweigh benefits when life expectancy is limited 2, 3

Rationale: Why the 10-Year Threshold Matters

The mortality benefit from mammography screening has a significant time lag before manifesting clinically:

• The long lead time between screening and mortality reduction means women must survive long enough to realize the benefit 2
• Women with shorter life expectancy face greater risk of overdiagnosis—detecting cancers that would never have become clinically significant in their remaining lifetime 2, 3
• As women age, competing causes of death increase, making breast cancer death less likely than death from cardiovascular disease, respiratory disease, or other conditions 2, 3

Common Pitfalls to Avoid

Pitfall #1: Using Age Alone as the Stopping Criterion

• Age 75 is a guideline, not an absolute cutoff—health status and comorbidities are more important than chronological age 1, 2
• A healthy 80-year-old with no comorbidities may benefit more from continued screening than a 72-year-old with multiple serious conditions 2, 3

Pitfall #2: Continuing Screening in Women with Limited Life Expectancy

• Women with dementia, end-stage organ failure, or metastatic cancer should not continue screening regardless of age 2, 3
• The 11-year time lag to benefit exceeds the life expectancy of most women with serious comorbidities 2

Pitfall #3: Failing to Reassess Screening Decisions as Health Status Changes

• As women develop new comorbidities or functional decline, the benefit-harm ratio shifts unfavorably 2, 3
• Periodic reassessment is necessary—a decision to continue screening at age 75 should be revisited at ages 77,80, etc. 2

Pitfall #4: Not Engaging in Shared Decision-Making

• Women should understand that continued screening after age 75 involves trade-offs: potential for early cancer detection versus false positives, anxiety, and overtreatment 2, 3
• The decision should incorporate the patient's values and preferences regarding these trade-offs 1, 3

Nuances in the Evidence

There is some divergence among major guideline organizations:

• The American College of Physicians takes a more conservative approach, recommending discontinuation at age 75 for average-risk women 1, 2, 3
• The American College of Radiology and American Cancer Society are more permissive, stating no upper age limit exists and emphasizing continuation based on health status 1, 4
• All organizations agree that life expectancy <10 years is the key threshold for stopping, regardless of which age-based recommendation is followed 1, 2, 3

The most recent and highest-quality evidence (2024 ACR Appropriateness Criteria) emphasizes that screening recommendations should be based upon life expectancy and competing comorbidities, rather than age alone, and that women should continue screening as long as they remain in overall good health and are willing to undergo examination and subsequent testing if abnormalities are identified 1