At what age or under what medical conditions should routine mammography be stopped in women, particularly those with significant comorbidities (e.g. advanced dementia, severe heart disease) or limited life expectancy?

When to Stop Mammography Screening

Discontinue routine mammography screening at age 75 or when life expectancy falls below 10 years, regardless of age. 1

Primary Stopping Criteria

The decision to stop screening should be based on life expectancy, not age alone. 1 The critical threshold is a 10-year life expectancy because it takes an average of 11 years before one death from breast cancer is prevented for every 1,000 women screened. 1

Age-Based Guidelines

• Women aged 75 years or older should discontinue screening mammography according to the American College of Physicians. 1
• The American Cancer Society does not set a specific stopping age but recommends continuing screening only as long as overall health is good and life expectancy exceeds 10 years. 1
• Women should not continue screening past age 75 unless they are in exceptionally good health with life expectancy substantially exceeding 10 years. 1

Life Expectancy Assessment Algorithm

Step 1: Determine baseline life expectancy by age

• Age 70 with no comorbidities: 19 years average life expectancy 1
• Age 75 with no comorbidities: 15 years average life expectancy 1
• Age 70 with serious comorbidities: 11 years average life expectancy 1
• Age 75 with serious comorbidities: 9 years average life expectancy 1

Step 2: Identify life-limiting comorbidities

Serious comorbidities that substantially reduce life expectancy include: 1

• Advanced dementia (moderate to severe)
• Severe heart failure (NYHA Class III-IV)
• End-stage renal disease requiring dialysis
• End-stage liver disease
• Oxygen-dependent chronic obstructive pulmonary disease
• Metastatic cancer

Step 3: Apply the decision rule

• If life expectancy < 5 years: Stop screening immediately 2
• If life expectancy 5-10 years: Consider stopping screening 2
• If life expectancy > 10 years: Continue biennial screening 1, 2

Rationale for the 10-Year Threshold

The mortality benefit from mammography requires approximately 11 years to fully manifest. 1 Women with shorter life expectancy face several critical disadvantages:

• Competing mortality risks increase with age and comorbidity burden, making death from other causes more likely than death from breast cancer. 1
• Harms of screening persist regardless of life expectancy, including false-positive results (occurring in approximately 200 per 1,000 women screened over 10 years), unnecessary biopsies (82 per 1,000 women), and overdiagnosis (13 per 1,000 women). 1, 3
• Overdiagnosis becomes increasingly problematic in older women, as indolent cancers that would never become clinically significant are detected and treated, causing harm without benefit. 1

Common Clinical Pitfalls to Avoid

Do not use age alone as the stopping criterion. 1 A healthy 78-year-old woman with no comorbidities may have sufficient life expectancy to benefit from continued screening, while a 72-year-old with severe heart failure and dementia should stop screening immediately.

Do not continue screening in women with advanced dementia, severe heart disease, or other life-limiting conditions simply because they are "only" 70 or 75 years old. 1 The presence of serious comorbidities dramatically reduces life expectancy below the 10-year threshold needed for benefit.

Recognize that the time lag to benefit is substantial. 1 Even if a cancer is detected today, the survival advantage from early detection versus later clinical detection takes years to materialize—time that women with limited life expectancy do not have.

Avoid the misconception that "one more mammogram won't hurt." 1 Each screening examination carries real harms including false-positives, anxiety, additional imaging, and potential biopsy, with diminishing likelihood of benefit as life expectancy decreases.

Special Considerations for Women with Prior Breast Cancer

For breast cancer survivors aged 75 or older, apply the same life expectancy thresholds for surveillance mammography: 2

• Discontinue when life expectancy < 5 years (even for high-risk cancers)
• Consider discontinuing when life expectancy 5-10 years
• Continue when life expectancy > 10 years

The risk of ipsilateral or contralateral breast cancer events in older survivors is relatively low (4-5% over 5 years), and most will die from non-breast cancer causes. 2, 4