Should an elderly woman continue to have mammograms (mammography)?

Mammography Screening in Elderly Women

Elderly women should continue mammography screening as long as they are in good health with a life expectancy of at least 10 years, regardless of chronological age. 1

Age-Based Screening Framework

Women Age 75 and Older

• No upper age limit exists for stopping mammography screening - the American Cancer Society explicitly does not set a stopping age for breast cancer screening 1
• Women aged 75+ in good health with expected longevity of 10 or more years should continue mammography screening 1
• More than one-third of all breast cancer deaths annually are attributable to women diagnosed after age 70, making continued screening potentially beneficial for healthy older women 1

Screening Frequency for Older Women

• Women aged 55+ should transition to biennial (every 2 years) screening or may continue annual screening based on personal preference 1
• Biennial screening provides adequate mortality benefit with fewer false-positive results in postmenopausal women 1
• Annual screening did not confer the same prognostic advantage in postmenopausal women compared to premenopausal women, except for those currently using menopausal hormone therapy 1

Life Expectancy Assessment

Clinicians must use mortality indices that incorporate age, comorbidities, and functional status when applying clinical judgment about longevity 1

When to Continue Screening

• Life expectancy >10 years: Continue mammography screening 1, 2
• Good overall health status with minimal comorbidities 1

When to Stop Screening

• Life expectancy <5 years: Discontinue routine mammography 3
• Life expectancy 5-10 years: Consider discontinuation, engage in shared decision-making 3
• Severe comorbidities that limit life expectancy 2

Evidence Supporting Continued Screening

• Breast cancer risk increases with age - age is the major risk factor for both developing and dying from breast cancer 4
• Modeling studies estimate 2 fewer breast cancer deaths per 1,000 women in their 70s who continue biennial screening for 10 years instead of stopping at age 69 4
• Observational studies favor extending screening to older women with >10 years life expectancy 4

Potential Harms in Older Women

• False-positive results occur in approximately 200 per 1,000 women screened over 10 years, leading to additional imaging and anxiety 4
• Overdiagnosis affects approximately 13 per 1,000 women screened over 10 years - detecting cancers that would not have become clinically significant 4
• The benefit of screening diminishes toward end of life when life expectancy is limited 5

Critical Pitfall to Avoid

Do not continue screening mammography when life expectancy is less than 10 years - the American College of Physicians explicitly recommends avoiding screening tests in this scenario 2. A concerning 28.5% of older breast cancer survivors received mammography during their last year of life, representing inappropriate overuse 5.

Practical Implementation

Assess the following factors to determine continuation:

• Functional status: Can the patient perform activities of daily living independently? 1
• Comorbidity burden: Use validated indices like the Charlson Comorbidity Index 1
• Patient preferences: Discuss whether potential benefits outweigh harms based on individual values 1
• Recent hormonal exposures: High bone mass or obesity are more predictive of late-life breast cancer than distant hormonal factors 4