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By Judy Mandell, AARP, February 2025
Screening guidelines stop at age 75, but some doctors continue to screen women well beyond.
Eight years ago, at age 77, I was diagnosed with breast cancer. I haven’t had a recurrence, but I’m still advised to get a mammogram every year. However, that’s not the case for many women my age.
In fact, routine mammograms are only recommended for women between the ages of 40 and 74, according to the latest guidelines from the U.S. Preventative Services Task Force (USPSTF). After that, the task force says women should decide together with their doctor whether to continue getting screened for breast cancer due to a lack of evidence that the benefits of screening outweigh the risks.
In 2019, roughly half (54.2 percent) of women aged 75 and older had a mammogram, according to federal data, compared with 78 percent of women aged 65 to 74. More than half of breast cancer deaths occur in women 70 and older, the latest data from the American Cancer Society shows.
What’s the harm in screening?
Letting cancer go undetected may seem more harmful than catching it early on, but still, doctors say there are some risks to screening, especially for older women.
Research shows that the risk of overdiagnosis — finding a slow-growing cancer or one that will not grow at all — is much higher in women aged 70 and older, and this risk increases with age. And treating such a cancer could cause additional harm for someone who is frail or has other health issues.
A recent study of nearly 55,000 women, published in the Annals of Internal Medicine, found that about 31 percent of breast cancer cases discovered in women aged 70 to 74 would likely not cause any symptoms or harm. That share jumped up to 47 percent for women 75 to 84 and 54 percent in women 85 and older.
Are mammograms covered for the 75-plus?
Yes. Medicare covers baseline mammograms as a free preventive service under Part B for women 40 and older. Diagnostic mammograms are subject to a 20 percent copayment after you’ve met your Part B deductible.
The problem, says Jayne Charlamb, M.D., director of the Breast Cancer High Risk Program at SUNY Upstate Medical University in Syracuse, New York, is that “we can't yet reliably tell which cancers will be one that will ultimately go on to kill a patient, and which ones won't.” So some patients end up going through taxing treatments — chemotherapy, radiation, surgery, medication — “for no good reason,” Charlamb says.
False positives are another risk to breast cancer screening, though these can happen at any age, and, according to a study published in JAMA Network Open, are less likely to happen in older women.
Charlamb says an imaging abnormality can lead to additional imaging tests or even a biopsy, and end up being a false alarm. “And while it's great that the patient doesn't have cancer, we just put the patient under a lot of stress, possibly had her miss work or time with family, and exposed her to the small (but real) risks of surgery and anesthesia,” Charlamb says. “So, the risk of false alarms is definitely something to weigh.”
For some women, IV contrast used in breast MRIs may cause reactions and unpleasant side effects. “The risk is small, but it's there, and should be considered,” Charlamb adds.
At 75-plus, many doctors adopt an individualized approach
The key for older women, subject matter experts say, is discussing the risks and benefits of screening with your doctor — and understanding that just because mammogram guidelines stop at 75, doesn’t mean you should stop getting one. In fact, the American Cancer Society recommends that physicians continue to screen older patients who are in good health and who will likely live 10 or more years.
“No two women are the same, and that includes women over 74,” says Nina Vincoff, M.D., medical director of the Katz Institute for Women's Health at Northwell Health in New Hyde Park, New York. “Many older women are in excellent health and lead active quality lives. Just like younger women, they have a lot to lose by developing an advanced breast cancer that may require debilitating surgery or chemotherapy.”
Here are a few things to consider when talking to your doctor about getting a mammogram at 75 and beyond:
Do you expect to live another 10 years?
When making breast cancer screening decisions with older patients, Charlamb doesn’t consider age, she looks at life expectancy — both quantity and quality.
“If a particular patient has underlying medical conditions (bad heart disease, for example), making it very unlikely she'll live another 10 years, it makes no sense for us to recommend she continue with regular mammograms since the odds of it helping her are unlikely. She's likely to die of her heart disease sometime in the next 10 years,” Charlamb says.
In fact, she adds, finding cancer in this situation may actually be harmful to the patient since surgery and chemotherapy can “make her quality of life lower in the time she has left.”
Are you at high risk for breast cancer?
Some women are at higher risk for breast cancer due to personal or family history, and for these women, “it is more likely to be logical to strongly consider continuing with screening,” Charlamb says. Also, consider asking your doctor your risk of developing breast cancer in the next 10 years and your risk compared to other women your age.
Can you handle a false positive?
If your mammogram results prompt your physician to order more tests, will you be able to tolerate the stress and additional steps?
“While one patient may be willing to endure the possibility of undergoing an otherwise unnecessary biopsy, if doing the biopsy ensures she might catch a cancer early, thus allowing her to possibly live longer, another patient might find the possibility of an unnecessary biopsy procedure intolerably horrible, and is willing to risk the small possibility of missing a small cancer,” Charlamb says. “This is why shared decision-making between a woman and her physician is so important.”
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