When to Stop Mammogram Screening in Average-Risk Women
There is no specific age to stop mammography screening; instead, continue screening as long as the woman has good overall health and a life expectancy of at least 10 years, with most guidelines recommending continuation at least until age 75 years. 1, 2
Age-Based Framework for Stopping Screening
Age 75 and Beyond: The Critical Decision Point
Continue screening beyond age 75 if life expectancy exceeds 10 years, as more than one-third of all breast cancer deaths occur in women diagnosed after age 70. 2
The American College of Physicians explicitly states that age alone should not determine when to stop screening, and decisions beyond age 75 should be based on shared decision-making informed by health status and longevity. 1
The American Cancer Society recommends continuing mammography as long as overall health is good and life expectancy is at least 10 years, with no upper age limit. 1, 2
The 10-Year Life Expectancy Rule
Stop screening when life expectancy falls below 10 years, as the American College of Physicians explicitly recommends avoiding screening tests in this scenario. 2
Use mortality indices that incorporate age, comorbidities, and functional status (such as the Charlson Comorbidity Index) to assess longevity rather than relying on chronological age alone. 2
Screening Frequency After Age 55
Women aged 55 and older should transition to biennial (every 2 years) screening or may continue annual screening based on personal preference and risk factors. 1, 3, 2
Biennial screening provides adequate mortality benefit with fewer false-positive results in postmenopausal women. 2
Evidence on Screening in Older Women
Benefits in the 75+ Age Group
One additional mammogram at age 75 prevents one breast cancer death per 1,000 average-risk women without comorbidities, though it also results in 52 false positives and 10% overdiagnoses. 4
Five additional screens over 10 years in 75-year-old women prevent four breast cancer deaths per 1,000 average-risk women but result in 238 false positives and 29-31% overdiagnoses. 4
Harms Increase with Age and Comorbidity
Screening women at ages 80 and 85, particularly those with high comorbidity levels, leads to fewer breast cancer deaths but a higher percentage of overdiagnoses. 4
The balance of benefits and harms shifts unfavorably as comorbidities accumulate and life expectancy decreases. 4
Guideline Variations to Note
The USPSTF concludes there is insufficient evidence to assess benefits and harms of screening in women 75 years or older, neither recommending for nor against it. 1
The Canadian Task Force on Preventive Health Care recommends screening only through ages 70-74 years with mammography every 2-3 years, but this represents a more conservative approach than U.S. guidelines. 1
The American College of Radiology and NCCN recommend annual screening beginning at age 40 and continuing without a specified upper age limit. 1
Practical Implementation Algorithm
Use this approach to determine when to stop screening:
At age 75 or older: Assess overall health status and comorbidity burden using validated tools like the Charlson Comorbidity Index. 2
Estimate life expectancy: If greater than 10 years, continue screening (biennial or annual based on preference). 2
If life expectancy is less than 10 years: Stop screening, as harms outweigh benefits. 2
Engage in shared decision-making: Discuss that continuing screening reduces breast cancer mortality by 15-20% but increases false positives and overdiagnosis risk. 3, 4
Common Pitfalls to Avoid
Do not use age 75 as an automatic cutoff—this is when individualized assessment should begin, not when screening must stop. 1
Do not continue screening in women with severe comorbidities or limited life expectancy—the harms of false positives, overdiagnosis, and unnecessary procedures outweigh mortality benefits. 2, 4
Do not ignore patient preferences—some women may value avoiding even one breast cancer death highly, while others may prioritize avoiding false positives and overdiagnosis. 4