What is the recommended screening plan for a 78-year-old female?

Screening Recommendations for a 78-Year-Old Female

For a 78-year-old woman in good health with a life expectancy exceeding 10 years, continue breast cancer screening with mammography every 1-2 years, discontinue cervical cancer screening if prior screening was adequate, and make individualized decisions about colorectal cancer screening based on prior screening history—while stopping routine screening for women with limited life expectancy or significant comorbidities. 1

Breast Cancer Screening

Continue mammography screening if the patient has good overall health and life expectancy ≥10 years. 2, 1

• The average life expectancy for a 78-year-old woman in the United States is approximately 12 years, which exceeds the 10-year threshold where screening benefits outweigh harms 1
• Women aged ≥55 years should continue screening mammography as long as overall health is good and life expectancy exceeds 10 years 1
• Mammography performs significantly better in older women with higher sensitivity, specificity, and cancer detection rates, accompanied by lower recall rates and false positives 3
• The overdiagnosis rate remains low, with benefits outweighing risks until age 90 years 3

For women in well-resourced settings aged 70-75 years, WHO suggests organized screening programs only in the context of rigorous research and shared decision-making, though this is a conditional recommendation based on low-quality evidence. 2

Key Considerations for Breast Screening Decision

• If the patient has limited life expectancy (<10 years) or poor health status, discontinue screening as the time to benefit from screening exceeds remaining life expectancy 2
• The probability of overdiagnosis and unnecessary treatment increases dramatically after age 70-75 years, particularly in women with shortened life spans 2
• Approximately 30% of screen-detected cancers in older women would not have become clinically apparent in their lifetime, yet nearly all undergo treatment with increasing treatment risks 4

Cervical Cancer Screening

Discontinue cervical cancer screening if the patient has had ≥3 consecutive negative Pap tests or ≥2 consecutive negative HPV and Pap tests within the last 10 years, with the most recent test in the last 5 years. 1

• Women aged >65 years meeting these criteria should stop cervical cancer screening 1

Colorectal Cancer Screening

Colorectal cancer screening decisions for adults aged 76-85 years should be based on prior screening history, overall health status, and life expectancy. 2, 1

Decision Algorithm for Colorectal Screening

• If the patient has had regular normal screening for years: Consider discontinuing screening, as modeling data suggest benefits may not exceed harms after age 75 years in those with prior screening history 2
• If the patient has never been screened and is in good health: Screening may provide significant benefit and should be considered 2
• If the patient is over age 85: Discourage continued screening, as modeling shows minimal incremental benefit unlikely to outweigh harms 1
• The highest rate of serious complications during and after colonoscopy occur in older adults 2

For patients continuing screening, colonoscopy every 10 years or annual fecal immunochemical test (FIT) are first-tier options. 5

Additional Recommended Screenings

Cognitive Screening

• Annual screening for cognitive impairment using Mini-Mental State Examination, Mini-Cog, or Montreal Cognitive Assessment 1

Metabolic Screening

• Diabetes screening with hemoglobin A1C, especially if BMI ≥25 kg/m² with additional risk factors 1
• Blood pressure measurement at every visit 1
• Lipid profile screening with intervals based on clinical judgment 1

Abdominal Aortic Aneurysm

• Not recommended for women at this age (screening is for men aged 65-75 years) 6

Critical Pitfalls to Avoid

• Do not continue cancer screening based solely on age—the critical determinant is whether life expectancy exceeds 10 years and overall health status 1
• Do not ignore prior screening history—patients with consistently normal prior screening results derive minimal benefit from continued screening 1
• Do not screen for endometrial cancer routinely—instead, counsel the patient to report any unexpected bleeding or spotting immediately 2
• Avoid breast self-examination recommendations—there is risk of harm from false-positive results and lack of evidence of benefit 2