At what age do we stop performing mammograms (Mammography)?

From the Guidelines

Women at average risk of breast cancer should stop screening mammography after age 75 years, as recommended by the American College of Physicians, unless they have a high risk of breast cancer or other individualized factors that warrant continued screening. When deciding to stop mammography, several factors should be considered, including the woman's overall health status, personal preferences, and the potential benefits versus harms of continued screening 1. The benefits of mammography decrease with age, while the potential harms, such as false positives, overdiagnosis, and unnecessary procedures, remain constant or increase 1. Some key points to consider when making this decision include:

• Age alone should not be the basis to continue or discontinue screening, but rather a shared decision-making process informed by the woman's health status and longevity 1
• Women with significant health problems or limited life expectancy may not benefit from continued mammography screening, as the time needed to benefit from mammography screening may exceed their remaining lifespan
• The decision to discontinue screening mammography should be based on a shared decision-making process, taking into account the woman's values and priorities regarding cancer detection versus potential screening harms 1. Key considerations for stopping mammography include:
• The woman's life expectancy and overall health status
• The potential benefits and harms of continued screening
• The woman's personal preferences and values regarding cancer detection and screening harms
• The presence of any individualized factors that may warrant continued screening, such as a high risk of breast cancer.

From the Research

Stopping Mammography Screening

• The decision to stop mammography screening is individualized and depends on various factors, including life expectancy, comorbidities, and personal values 2, 3, 4.
• For women with a life expectancy of less than 10 years, the potential harms of screening may outweigh the benefits, and recommendations to stop screening mammography should emphasize increased potential harms from screening 2.
• Women with a life expectancy of more than 10 years should discuss the potential benefits and harms of screening with their healthcare provider, as the decision to continue screening becomes a value judgment for patients 2, 4.
• Observational data support a survival benefit from regular screening in older women with no severe comorbidities 3, 4.
• The performance of screening mammography in older women is better than in younger age groups, tipping the balance toward greater benefits than harms 4.

Life Expectancy and Comorbidities

• Life expectancy is a major factor in determining the benefits and harms of screening mammography in older women 2, 3, 4.
• Women with severe comorbidities or limited life expectancy may not benefit from screening mammography 3, 4.
• Healthcare providers should consider a woman's individual risk profile, comorbid conditions, and personal values when making decisions about screening mammography 4.

Screening Strategies

• Biennial screening in older women preserves some of the benefit of screening, but annual mammography achieves the greatest reductions in breast cancer mortality and morbidity 4.
• Digital breast tomosynthesis (DBT) may improve performance metrics in older women, but more research is needed to confirm this 4.