At what age can an average-risk woman stop getting mammograms?

When to Stop Mammography Screening in Average-Risk Women

For average-risk women, there is no specific age to automatically stop mammography screening; instead, discontinue screening when life expectancy falls below 10 years, which should be assessed through shared decision-making beginning around age 75. 1

Age 75 as a Decision Point, Not a Cutoff

• Age 75 marks when individualized assessment should begin, not when screening automatically stops. 2, 1
• The American College of Obstetricians and Gynecologists explicitly states that "age alone should not be the basis to continue or discontinue screening" and that "beyond age 75 years, the decision to discontinue screening mammography should be based on a shared decision making process informed by the woman's health status and longevity." 2
• More than one-third of all breast cancer deaths occur in women diagnosed after age 70, making continued screening potentially beneficial for healthy older women. 1

The 10-Year Life Expectancy Threshold

Stop screening when life expectancy falls below 10 years, as this is the timeframe needed to realize mortality benefits from screening. 2, 1

Practical Life Expectancy Assessment:

• Women aged 70 with no comorbidities: Average life expectancy is 19 years (continue screening) 2
• Women aged 75 with no comorbidities: Average life expectancy is 15 years (continue screening) 2
• Women aged 70 with serious comorbidities: Average life expectancy is approximately 11 years (individualize decision) 2
• Women aged 75 with serious comorbidities: Average life expectancy is approximately 9 years (consider stopping) 2

Guideline Variations Across Organizations

Organizations Supporting Continued Screening Beyond 75:

• American Cancer Society: Continue mammography as long as overall health is good and life expectancy is at least 10 years, with no upper age limit. 1
• American College of Radiology and NCCN: Recommend annual screening beginning at age 40 and continuing without a specified upper age limit. 1, 3
• American College of Obstetricians and Gynecologists: Women should continue screening until at least age 75, with decisions beyond that based on health status. 2

Organizations With More Conservative Positions:

• 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

Benefits vs. Harms in Older Women

Benefits of Continued Screening:

• Mammography screening reduces breast cancer mortality by 15-20% across age groups. 1, 4
• Mammography performs significantly better in older women with higher sensitivity, specificity, cancer detection rate, and positive predictive values, accompanied by lower recall rates and false positives. 5
• The overdiagnosis rate is low, with benefits outweighing risks until age 90 years. 5
• Modeling studies estimate 2 fewer breast cancer deaths per 1,000 women who continue biennial screening in their 70s for 10 years instead of stopping at age 69. 6

Harms of Continued Screening:

• False-positive mammograms occur in approximately 200 per 1,000 women screened over 10 years. 6
• Overdiagnosis (finding breast cancer that would not have become clinically evident) occurs in approximately 13 per 1,000 women screened over 10 years. 6
• Additional anxiety and unnecessary procedures from false positives. 6

Clinical Algorithm for Decision-Making

Step 1: At Age 75 or Older, Assess Overall Health Status

• Use validated tools like the Charlson Comorbidity Index to assess comorbidity burden. 1
• Estimate life expectancy based on age and comorbid conditions. 1

Step 2: Apply the 10-Year Life Expectancy Rule

• If life expectancy >10 years: Continue screening (annual or biennial based on preference). 1
• If life expectancy <10 years: Discontinue screening, as harms outweigh benefits. 1

Step 3: Engage in Shared Decision-Making

• Discuss that continuing screening reduces breast cancer mortality by 15-20% but increases false positives and overdiagnosis risk. 1
• Consider patient values, preferences, and understanding of screening outcomes. 6

Common Pitfalls to Avoid

• Do not use age 75 as an automatic cutoff for screening—individualized assessment should begin at this age, not end screening. 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. 1
• Do not ignore the patient's functional status—women who are frail or have multiple comorbidities are unlikely to benefit from screening even if chronologically younger than 75. 2

Screening Frequency After Age 55

• Women aged 55 and older should transition to biennial screening or may continue annual screening based on personal preference and risk factors. 1, 4
• Biennial screening after age 55 is a reasonable option to reduce the frequency of harms, as long as patient counseling includes discussion that decreased screening comes with some reduction in benefits. 2