Breast Cancer Screening in Older Women: The Importance of Shared Decision Making

Sarina Schrager, MD, MS; Viktoriya Ovsepyan, BA; Elizabeth Burnside, MD, MS, MPH


J Am Board Fam Med. 2020;33(3):473-480. 

In This Article

Abstract and Introduction


Incidence of breast cancer increases with age up until age 80. Screening mammography has demonstrated efficacy in decreasing mortality from breast cancer among women between 50 and 74 years of age. However, most major organizations do not include women over 74 in their recommendations due to the lack of evidence in this age-group. This article will review current recommendations for breast cancer screening in women over the age of 74. It will also present clear guidelines for primary care clinicians to follow that incorporate shared decision-making techniques, tools for estimating the risks and benefits of screening mammography, and strategies for integrating a patient's life expectancy and comorbidities into the decision-making process. We also emphasize the importance of using thoughtful communication strategies to fully engage older women in the breast cancer screening discussion.