When to Stop Mammography Screening
Discontinue routine mammography screening at age 75 or when life expectancy falls below 10 years, whichever comes first. 1, 2
Primary Stopping Criteria
The decision to stop mammography must be based on two key thresholds: chronological age of 75 years OR estimated life expectancy less than 10 years, regardless of actual age. 1, 2 This recommendation is driven by the critical fact that it takes an average of 11 years before one death from breast cancer is prevented for every 1,000 women screened—meaning women with shorter life expectancy will not live long enough to benefit from screening. 1, 2
Life Expectancy Assessment Algorithm
To determine whether a woman has sufficient life expectancy to benefit from continued screening, use the following framework:
For women aged 70 years:
- No comorbidities: average life expectancy = 19 years (continue screening) 1, 2
- Serious comorbidities: average life expectancy = 11 years (borderline; consider stopping) 1, 2
For women aged 75 years:
- No comorbidities: average life expectancy = 15 years (may continue if excellent health) 1, 2
- Serious comorbidities: average life expectancy = 9 years (discontinue screening) 1, 2
Life-Limiting Comorbidities That Mandate Stopping
Discontinue screening immediately in women with any of these conditions, regardless of age: 2
- Advanced dementia
- Severe heart failure (NYHA Class III-IV)
- End-stage renal disease (dialysis-dependent)
- End-stage liver disease (cirrhosis with complications)
- Oxygen-dependent chronic obstructive pulmonary disease
- Metastatic cancer
These conditions substantially reduce life expectancy below the 10-year threshold needed to benefit from screening. 2
Why the 10-Year Threshold Matters
The mortality benefit from mammography requires approximately 11 years to fully manifest. 1, 2 Women with shorter life expectancy face:
- Competing mortality risks: death from other causes becomes more likely than death from breast cancer 2
- Persistent harms: false-positive results (200 per 1,000 women screened over 10 years), unnecessary biopsies, and overdiagnosis (13 per 1,000 women) continue regardless of life expectancy 3
- Overdiagnosis increases with age: 10% of detected cancers at age 75 represent overdiagnosis, rising to 29-31% for women screened from age 75-85 4
Critical Pitfalls to Avoid
Do not use age alone as the stopping criterion. 1, 2 A healthy 78-year-old woman with no comorbidities and excellent functional status may have a life expectancy exceeding 10 years and could benefit from continued screening. 1, 5 Conversely, a 72-year-old woman with severe heart failure and dementia should stop screening immediately. 2
Do not fall into the "one more mammogram won't hurt" trap. 2 Each additional screening test in women with limited life expectancy increases the risk of false-positives, unnecessary biopsies, and detection of cancers that would never have caused symptoms or death during their remaining lifetime. 2, 4
Divergence in Guidelines
While the American College of Physicians provides a firm age cutoff of 75 years 1, 2, the American Cancer Society recommends continuing screening beyond age 75 if overall health is good and life expectancy exceeds 10 years. 5 The most conservative and evidence-based approach is to use age 75 as a default stopping point, with continuation only for exceptionally healthy women with documented life expectancy greater than 10 years. 1, 2 This prioritizes avoiding the harms of screening in women unlikely to benefit.
Special Consideration: Breast Cancer Survivors
For older breast cancer survivors requiring surveillance mammography (not screening), different considerations apply. Discontinue routine surveillance mammography when life expectancy is less than 5 years; consider discontinuation when life expectancy is 5-10 years; continue when life expectancy exceeds 10 years. 6 However, clinical breast examinations and diagnostic mammography for symptoms should continue regardless of surveillance decisions. 6