Rachel Freedman, MD, MPH, is a medical oncologist in the breast oncology center in the Susan F. Smith Center for Women’s Cancers at Dana-Farber Cancer Institute (DFCI). She is also a clinical researcher and Medical Director of the DFCI Cancer Care Collaborative. She researches disparities in breast cancer treatment and outcomes for minority patients and older patients. She is a member of the Cancer.Net Editorial Board’s geriatric oncology advisory panel.
For women with no history of cancer, U.S. screening guidelines recommend that all women start receiving mammograms when they turn 40 or 50 and to continue getting one every 1 or 2 years. This routine continues until they turn about 75 years of age or if, for whatever reason, they have limited life expectancy. At that point, whether a woman continues to have mammograms depends on thoughtful discussion between the woman and her health care team about what is appropriate for her specific situation.
However, after an older woman is treated for breast cancer, it is less clear when mammography should continue and when it should stop. The American Society of Clinical Oncology (ASCO) and American Cancer Society recommend that women who have had 1 breast removed with unilateral mastectomy have a mammogram on the intact breast every year. Women who have had a lumpectomy should have a mammogram of both breasts every year. The goal of these mammograms is to find cancer that comes back in the affected breast, called a recurrence, or to detect a new breast cancer in either breast that may occur over time. However, there are questions about how long breast cancer survivors should continue to receive mammograms if they are older than 75 or if other medical conditions may shorten their lives. Older patients have not been well represented in breast cancer research, and this has led to recommendations that are applied to all women with breast cancer. Because these guidelines do not address older women specifically, they often continue having these tests as a habit, without much discussion about the risks and benefits of mammograms.
Most women will benefit from mammograms for many years after they are diagnosed with breast cancer. But there are also women who will not benefit as much and can consider stopping mammograms. Stopping mammograms does not mean that women will not continue to receive proper care, follow-up with their providers, or physical examinations, but it does mean that mammograms may not lead to better outcomes for certain women.
Here are 2 situations in which a woman might want to stop having mammograms:
If a woman is older and has other significant medical conditions, like heart disease or stroke, particularly when these conditions affect one’s physical function and mobility. In older patients treated for breast cancer, these other medical conditions often pose a greater risk of dying. So for patients who face significant medical challenges, it is not clear that continuing mammography forever makes sense.
Women treated for a lower-risk breast cancer who are on medications to help prevent additional cancers from forming. These medications, such as tamoxifen or aromatase inhibitors, lower the risk that there will be another breast cancer, so the role of mammograms may be less important.
Mammograms also have risks that are important to consider when making a decision. There can be mild discomfort during the testing. Based on a mammogram’s result, there is also the chance that women will undergo a biopsy that finds no cancer, called false positives. There is also a risk for something called “overtreatment.” This is when mammography finds a cancer that would not affect a woman’s life span but may result in her getting treatments that she may not have needed.
In the end, you should ask your doctor about how mammograms may or may not help you and what the recommendations are for your situation. This is a very personal decision, and you and your health care team should work together to make this decision so that it feels right for you.