At what age do we discontinue mammography (mammograms)?

From the Guidelines

Women with average risk should continue screening mammography until at least age 75 years, and the decision to discontinue screening beyond this age should be based on a shared decision-making process informed by the woman's health status and longevity. The American College of Physicians recommends biennial screening mammography, particularly after age 55 years, as a reasonable option to reduce the frequency of harms, as long as patient counseling includes a discussion that with decreased screening comes some reduction in benefits 1.

When considering discontinuing mammograms, several factors should be taken into account, including the woman's overall health, life expectancy, and personal preferences. Women with serious health conditions or limited life expectancy may benefit from stopping mammograms earlier, as the potential benefits of screening may be outweighed by the potential harms. On the other hand, women with good health and a life expectancy of more than 10 years may continue screening beyond age 75 after discussing with their healthcare provider.

The American Cancer Society recommends that women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years, and women aged 55 years and older should transition to biennial screening or have the opportunity to continue screening annually 1. However, the decision to discontinue screening mammography should be individualized and based on a shared decision-making process.

Some key points to consider when deciding when to stop doing mammograms include:

• Age alone should not be the basis to continue or discontinue screening 1
• Women with good health and a life expectancy of more than 10 years may continue screening beyond age 75 after discussing with their healthcare provider
• Women with serious health conditions or limited life expectancy may benefit from stopping mammograms earlier
• The decision to discontinue screening mammography should be based on a shared decision-making process informed by the woman's health status and longevity
• Breast self-awareness and encouraging women to notify their healthcare provider if they experience a change are important aspects of breast cancer screening 1.

Ultimately, the decision to discontinue mammogram screening should be made on an individual basis, taking into account the woman's unique health status, risk factors, preferences, and values, as well as the potential benefits and harms of screening.

From the Research

Stopping Mammograms

• There is no specific age at which mammograms should be stopped, as the decision to continue screening depends on various factors, including the individual's health status and life expectancy 2, 3, 4.
• The American College of Radiology (ACR) and the Society of Breast Imaging recommend annual mammography screening starting at age 40, with no upper age limit unless severe comorbidities limit life expectancy 2.
• Studies have shown that older women undergoing regular mammography experience significant reductions in breast cancer mortality, except in women with severe comorbidities or limited life expectancy 3, 4.
• A decision analysis model found that screening saved life at all ages among patients studied, with savings highest for black women and decreasing with increasing age and comorbidity 4.
• However, another study found that the risks of screening may outweigh the benefits for women aged 85 years and older, particularly those with comorbidities or functional limitations 4, 5.
• The US Preventive Services Task Force found that evidence comparing the effectiveness of different breast cancer screening strategies is inconclusive, and more research is needed to determine the optimal screening ages, intervals, and modalities 6.

Considerations for Stopping Mammograms

• Severe comorbidities or limited life expectancy may be a reason to stop mammograms, as the benefits of screening may not outweigh the risks 2, 3, 4.
• Functional limitations, such as impairment of vision, audition, cognition, and mobility, may also be a consideration, as they may affect an individual's ability to undergo mammography or tolerate treatment 5.
• Individualized decision-making, taking into account a woman's health status, preferences, and values, is essential for determining when to stop mammograms 2, 3, 4, 5.