Mammography Screening Timeline for a 73-Year-Old Woman with History of Breast Cancer
For a 73-year-old woman with a personal history of breast cancer, annual mammography surveillance is recommended, not the standard screening intervals used for average-risk women. This patient requires ongoing surveillance mammography, which differs fundamentally from screening mammography used in women without prior breast cancer.
Critical Distinction: Surveillance vs. Screening
Your question mentions seeing a gynecologic oncologist for breast cancer, which indicates this patient has a personal history of breast cancer. This is a crucial distinction that changes the entire approach:
- Women with prior breast cancer require annual surveillance mammography regardless of age, as they are at significantly elevated risk for recurrence and contralateral breast cancer 1, 2
- The standard screening intervals (biennial or triennial) discussed in guidelines apply only to average-risk women without prior breast cancer 3
Surveillance Mammography Protocol
Annual bilateral mammography should continue indefinitely as long as the patient:
- Remains in reasonably good health 3, 4
- Has a life expectancy that would allow benefit from detecting and treating a recurrence 4
- Is willing to undergo additional testing if abnormalities are detected 5
Life Expectancy Considerations
For this 73-year-old patient with diabetes and hypertension:
- If comorbidities are mild to moderate: A 70-year-old woman without severe comorbidities has an average life expectancy of approximately 19 years, and even with some comorbidities may have 10+ years of life expectancy, justifying continued annual surveillance 5, 4
- If comorbidities are severe (such as congestive heart failure, end-stage renal disease on dialysis, oxygen-dependent COPD, or moderate-to-severe dementia): Life expectancy may be less than 5 years, and surveillance may provide minimal benefit 4
When to Consider Stopping Surveillance
Surveillance mammography should be discontinued only when:
- Severe comorbidities limit life expectancy to less than 5 years 4
- The patient develops conditions that would preclude treatment of a detected cancer 3, 4
- The patient chooses to stop after informed discussion of risks and benefits 3
Important Caveats
Common pitfall: Do not apply average-risk screening guidelines to women with prior breast cancer. The European guidelines suggesting triennial screening for women aged 70-74 3 and U.S. guidelines recommending biennial screening 3 apply only to women without prior breast cancer history.
Quality assurance: Ensure mammography is performed at accredited facilities with appropriate quality standards 3, 5
Enhanced screening considerations: Women with prior breast cancer and dense breasts should strongly consider supplemental breast MRI in addition to annual mammography 2
The absence of family history does not reduce this patient's risk—her personal history of breast cancer is the dominant risk factor requiring annual surveillance 1, 2.