At what age or under what conditions should breast cancer screening be stopped in women?

When to Stop Breast Cancer Screening

Breast cancer screening should be discontinued at age 75 or when life expectancy falls below 10 years, whichever comes first. 1

Primary Stopping Criteria

The decision to stop screening is based on two key thresholds that reflect when harms outweigh benefits:

• Age 75 years or older: Discontinue routine mammography screening regardless of health status in most cases 1
• Life expectancy <10 years: Stop screening at any age when estimated survival is less than 10 years 1

The 10-year threshold is critical because mammography requires approximately 11 years before preventing one breast cancer death per 1,000 women screened—meaning women with shorter life expectancy cannot realize the mortality benefit while still experiencing all the harms. 1

Life Expectancy Assessment Algorithm

For women aged 70-75 years, estimate life expectancy using age and comorbidity burden:

Women Age 70:

• No significant comorbidities: Average life expectancy = 19 years → Continue screening 1
• Serious comorbidities: Average life expectancy = 11 years → Consider stopping 1

Women Age 75:

• No significant comorbidities: Average life expectancy = 15 years → Individualize decision 1
• Serious comorbidities: Average life expectancy = 9 years → Stop screening 1

Women Age 80-85:

• Even healthy women at these ages have diminishing benefit-to-harm ratios, with modeling showing increased overdiagnosis rates (29-31%) when continuing screening. 2

Life-Limiting Comorbidities That Mandate Stopping

Discontinue screening immediately in women with any of these conditions, regardless of age: 1

• Advanced dementia or severe cognitive impairment
• Severe heart failure (NYHA Class III-IV)
• End-stage renal disease requiring dialysis
• End-stage liver disease (cirrhosis with complications)
• Oxygen-dependent chronic obstructive pulmonary disease
• Metastatic cancer or terminal malignancy
• Combinations of moderate comorbidities (cardiovascular disease, diabetes, paralysis)

Why the 10-Year Rule Matters

The evidence strongly supports this threshold based on the biology of screening benefit:

• Time lag to benefit: It takes 11 years on average for mammography to prevent one breast cancer death per 1,000 women screened 1
• Competing mortality risks: Older women and those with comorbidities are far more likely to die from other causes before breast cancer would become life-threatening 1
• Persistent harms: False-positive results, unnecessary biopsies, overdiagnosis, and treatment complications occur immediately and don't diminish with age 1, 2

Recent modeling data from 2024 demonstrates that screening women at age 75 results in 10% overdiagnosis with one additional screen, rising to 29-31% overdiagnosis with five additional screens over 10 years. 2

Evidence Strength and Guideline Consensus

All major guidelines converge on these stopping criteria:

• The American College of Physicians (2019) provides the strongest recommendation to discontinue at age 75 or life expectancy <10 years 1
• The American Cancer Society (2015) recommends continuing only when health is good and life expectancy exceeds 10 years 1
• The U.S. Preventive Services Task Force (2016) notes insufficient evidence for screening beyond age 74, with models suggesting women with moderate-to-severe comorbidities are unlikely to benefit 1

The WHO specifically recommends screening women aged 70-75 only in the context of shared decision-making and rigorous research programs, acknowledging the limited evidence base. 1

Common Clinical Pitfalls to Avoid

Do not use age alone as the stopping criterion. A healthy 78-year-old with 15+ years of life expectancy may benefit from continued screening, while a 72-year-old with severe heart failure will not. 1, 3

Do not fall into the "one more mammogram won't hurt" trap. Each additional screen carries immediate harms (false positives in ~200/1,000 women over 10 years) while the mortality benefit requires over a decade to materialize. 1, 2, 4

Do not continue screening in women with advanced dementia or terminal conditions simply because they are "only" 70-75 years old. These women face competing mortality risks that eliminate any potential screening benefit. 1, 5

Recognize that overdiagnosis increases dramatically with age. Women screened in their 80s have a 29-31% chance of overdiagnosis—detecting cancers that would never have caused symptoms or death in their remaining lifetime. 2

Practical Implementation

When a woman reaches age 75 or develops life-limiting comorbidities:

1. Calculate estimated life expectancy using age, functional status, and comorbidity burden 1, 5
2. If life expectancy <10 years: Recommend stopping screening and explain the 11-year time lag to benefit 1
3. If life expectancy >10 years and age 75-79: Discuss that benefits are marginal and harms persist, allowing patient preference to guide decision 1
4. If age ≥80: Strongly recommend stopping given insufficient evidence of benefit and high overdiagnosis rates 1, 2

The evidence is clear that continuing screening beyond these thresholds shifts the balance toward net harm rather than net benefit. 1, 2