Mammograms are X-ray exams of the breast that can detect tumors that are too small to feel. Screening mammograms are used to check for breast cancer in women who do not have signs or symptoms of the disease. While mammograms are an important screening tool for breast cancer, current guidelines recommend against routine screening mammography for women aged 75 and older.
Current Screening Recommendations
Here are the current recommendations from leading health organizations on mammogram screening for older women:
- The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74. They recommend against routine screening mammograms for women aged 75 and older.
- The American Cancer Society (ACS) recommends yearly mammograms starting at age 45 and continuing as long as a woman is in good health. They note insufficient evidence to assess the benefits and harms of screening mammography in women aged 75 and older.
- The American College of Radiology (ACR) and Society of Breast Imaging (SBI) recommend annual mammograms beginning at age 40 with no set age to stop screening.
So while guidelines vary, most major organizations agree that routine screening mammograms for women over 75 or those with serious comorbid conditions are of limited benefit.
Why the Difference After Age 74?
There are several reasons why routine mammogram screening is not recommended after 74:
- Decreased life expectancy – The benefits of finding breast cancer early decline as women have fewer expected remaining years of life. The harms of overdiagnosis and overtreatment outweigh benefits in older women with limited life expectancy.
- Higher false positive rates – Mammogram false positive rates are higher in older women leading to more unnecessary testing and procedures.
- Lower sensitivity – Mammogram sensitivity decreases with age due to higher breast density in older women making tumors harder to detect.
- Slower tumor growth – Breast cancer tumors tend to grow more slowly in older women, so early detection is less crucial.
- Comorbidities – Older women are more likely to have other significant health conditions that reduce suitability for breast cancer treatment.
Potential Harms of Screening After Age 74
While finding cancer early has clear benefits, mammogram screening for women over 74 may lead to the following potential harms:
- False positive test results leading to additional imaging tests and biopsies.
- Detection and treatment of non-life threatening, slow growing cancers (overdiagnosis).
- Psychological stress and anxiety from false positives and overdiagnosis.
- Unnecessary radiation exposure from additional testing.
- Complications from biopsies and cancer treatment in older, potentially frail patients.
These potential downsides need to be weighed carefully against the decreasing benefits of screening in older women with limited life expectancy.
Special Considerations
While routine screening is not recommended after age 74, there are some important special considerations:
- Women with a significant family history of breast cancer or other breast cancer risk factors should discuss continued screening with their doctor.
- Women in good health with a life expectancy of 10 or more years should also have a conversation with their doctor about whether to continue screening.
- Any concerning breast symptoms should prompt an immediate medical evaluation regardless of age.
- Older women stopping routine screening should be aware of potential breast cancer signs and symptoms.
Discussion with Your Doctor
The decision to continue or stop mammogram screening after age 74 should be an individual one made by each woman with her health care providers. Important factors to weigh include current health, family history, personal priorities, and risks versus benefits. Women in this age group should have a discussion with their doctor covering:
- Current health status and life expectancy
- Family history of breast cancer
- Potential benefits and downsides of continuing screening
- Understanding of breast cancer risks and signs/symptoms
- Personal preferences and values around screening
This information can help each woman make the mammography decision right for her after age 74.
Conclusion
In summary, routine mammogram breast cancer screening is generally not recommended for women aged 75 and older. This is due to decreasing benefits and increasing harms as women have fewer expected remaining years of life. However, some older women may still benefit from screening depending on individual risk factors and health status. Women should discuss the pros and cons of continuing mammograms with their doctor after age 74. While routine screening stops, all older women should remain vigilant about potential breast cancer symptoms and report any concerning findings.