One question that I commonly hear from my patients is “At what age can a woman stop having a screening mammogram?” Although there is not a simple answer to this question, there is now enough information about this subject for a woman to make an informed decision about herself or her aging relatives.
First, let’s start with the good news. Multiple well-designed scientific studies have demonstrated a 30-40 percent reduction in breast cancer mortality in women who do yearly mammograms. Things will get even better in the future as we move more towards aggressively screening high-risk women and women with dense breasts. Most of the information on the value of screening mammography is on women who are 40 to 74 years old, and we have a very limited amount of information on the value of screening mammograms for women 75 years and older. (Note that I am referring to screening, which means that the woman has no symptoms such as a lump or nipple discharge. Women with symptoms should undergo diagnostic work at any age, as long as they are in reasonable health).
Fortunately, a recent study presented at the annual meeting of the American Association for Cancer Research (AACR) provides an important perspective on the issue of screening women who are over 75 years of age. Basically, a study was described which indicated that not doing regular mammograms in women over 75 years of age, led to a greater chance of dying from breast cancer. The study concluded that for otherwise healthy women 75 and older, screening is indicated. It is important to remember that the average lifespan for an 80-year-old woman is 9 years.
One of the generally cited indications for stopping screening is if life expectancy is less than 5 years. Of course, estimating life expectancy is fraught with problems, but there are obvious situations where common sense applies. For example, it would be reasonable to stop mammographic screening in patients with advanced heart disease, advanced dementia, or advanced cancers.
The best summary of the advice on the subject comes from the American Geriatric Society, which has issued the following statement: “The most significant risk of screening the women over 75 years of age is the detection of tumors that may not become clinically important during a patient’s lifetime. The American Geriatrics Society encourages screening mammography for women younger than 85 who have at least 5 years’ life expectancy and for healthy women 85 and older who have excellent functional status or who feel strongly about the benefits of screening. When you discuss stopping screening with older women who have shorter life expectancies, it is important to address the issues that make women want to continue screening, including habit and the need for reassurance.”