At what age should mammograms be discontinued for an 84-year-old patient with a history of breast cancer?

From the Guidelines

For an 84-year-old woman with a history of breast cancer, mammograms should not automatically stop at any specific age, but rather continue as long as she remains in overall good health and is willing to undergo subsequent testing or biopsy, if an abnormality is identified. The decision to continue or discontinue mammography screening should be individualized based on overall health status, life expectancy, and personal preferences, as there is no upper age limit agreed upon for screening mammography 1. According to the American College of Radiology, women should continue screening as long as they remain in overall good health and are willing to undergo the examination and subsequent testing or biopsy, if an abnormality is identified 1.

Some key points to consider in this decision include:

• The benefit of continued mammography in breast cancer survivors, who have an increased risk of developing a new breast cancer compared to women without a history of breast cancer 1
• The potential decrease in benefits of mammography with increasing age, particularly beyond 80-85 years, while the burdens of testing remain 1
• The importance of considering life expectancy and competing comorbidities, rather than age alone, in making screening recommendations 1
• The value of early detection of breast cancer, which can decrease treatment morbidity and mortality, as demonstrated by multiple randomized controlled trials and observational studies 1

Ultimately, the decision to continue or discontinue mammography screening should be made through a discussion with a healthcare provider, considering the individual's specific health status, breast cancer history, treatment options if cancer is detected, and personal values and preferences.

From the Research

Mammography Screening for Breast Cancer in Older Women

• The decision to stop mammography screening for an 84-year-old woman with a past history of breast cancer depends on various factors, including life expectancy and overall health status 2, 3.
• A study published in 2022 found that the utilization of mammography during the last year of life among older breast cancer survivors decreased with age, with a sharp decline after approximately 80 years old 2.
• Another study from 2018 suggested that older women with severe comorbidities or limited life expectancy may not benefit from regular mammography screening 3.
• The American College of Radiology and other professional organizations recommend that breast cancer screening decisions for women over 75 years old be individualized based on their health status and life expectancy 3, 4.

Factors Influencing Mammography Screening Decisions

• Life expectancy is a crucial factor in determining the benefits and risks of mammography screening in older women 2, 3, 4.
• Comorbidities and overall health status also play a significant role in deciding whether to continue or stop mammography screening 2, 3, 4.
• The type and stage of breast cancer, as well as the patient's history, can also influence the decision to continue or discontinue mammography screening 5, 4.

Recommendations for Mammography Screening in Older Women

• The American College of Radiology and other professional organizations recommend that breast cancer screening decisions for women over 75 years old be individualized based on their health status and life expectancy 3, 4.
• For women with a life expectancy of less than 5-10 years, the benefits of mammography screening may be diminished, and alternative screening strategies may be considered 2, 3.
• A comprehensive geriatric assessment can help evaluate an older woman's overall health status and inform decisions about mammography screening 4.