At what life expectancy should mammography (mammogram) screening be discontinued?

When to Discontinue Mammography Screening

Discontinue screening mammography at age 75 or when life expectancy falls below 10 years, whichever comes first. 1, 2, 3

Primary Decision Algorithm

Step 1: Age Assessment

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

Step 2: Life Expectancy Estimation

• If estimated life expectancy is <10 years → discontinue screening 1, 2, 3
• If estimated life expectancy is ≥10 years AND patient is in good health → continue screening 1, 2

Rationale: Why 10 Years Matters

The 10-year threshold is not arbitrary—it reflects the biology of screening benefit:

• It takes approximately 11 years before 1 death from breast cancer is prevented per 1,000 women screened 1, 2
• Women with shorter life expectancy will not live long enough to experience mortality reduction from screening 1, 2
• The time lag between detecting cancer and preventing death means screening provides no survival benefit when life expectancy is limited 2

Life Expectancy Estimation by Age and Comorbidity

For women aged 70 years: 1, 2, 3

• No comorbid conditions: 19 years average life expectancy
• Serious comorbid conditions: 11 years average life expectancy

For women aged 75 years: 1, 2, 3

• No comorbid conditions: 15 years average life expectancy
• Serious comorbid conditions: 9 years average life expectancy

Serious comorbidities that significantly limit life expectancy include: 1, 2, 3

• End-stage renal disease
• Severe heart failure (NYHA Class III-IV)
• Advanced dementia
• End-stage liver disease
• Chronic obstructive pulmonary disease with severe functional limitation
• Metastatic cancer

Why Harms Outweigh Benefits in Older Women with Limited Life Expectancy

False-positive results become increasingly problematic: 1, 2

• Approximately 200 per 1,000 women screened over 10 years will experience false-positive mammograms
• 12-27% of screened older women will have false-positive results requiring additional imaging or biopsy 4

Overdiagnosis and overtreatment are substantial concerns: 1, 2, 5

• Approximately 13 per 1,000 women screened over 10 years will be overdiagnosed with cancers that would never have become clinically significant
• 30% of screen-detected cancers in older women would not have surfaced in their lifetime 4
• Nearly all older women undergo treatment for these overdiagnosed cancers, despite no survival benefit 4
• Treatment risks increase with age and comorbidity burden 4

Critical Pitfalls to Avoid

Do not use age alone as the sole criterion 1, 2, 3

• A healthy 78-year-old with 15+ years life expectancy may benefit from continued screening
• A 72-year-old with severe heart failure and 8-year life expectancy should stop screening

Do not continue screening in women with serious comorbidities 1, 2, 3

• Women with conditions limiting life expectancy to <10 years will experience only harms, not benefits
• The competing risk of death from other causes exceeds any potential breast cancer mortality reduction 1, 5

Recognize that older women face higher competing mortality risks 1, 5

• While breast cancer risk increases with age, the probability of dying from other causes increases even more dramatically
• This shifts the benefit-harm ratio unfavorably for continued screening 1, 5

Special Consideration: No Upper Age Limit for Healthy Women

The American Cancer Society guideline states there is no specific upper age at which screening must stop—as long as a woman is in good health and would be a candidate for breast cancer treatment, she should continue screening 1. However, this recommendation must be balanced against the American College of Physicians' more conservative guidance to discontinue at age 75 1, 3. The most recent and pragmatic approach is to use age 75 as a general stopping point while allowing continuation in exceptionally healthy women with life expectancy substantially exceeding 10 years 1, 2, 3.