Cancer screening does not necessarily end when a woman turns 65, 70 or 75.
As women get older, the conversation changes. Mammograms, cervical cancer tests and colorectal cancer screening may still make sense, but the decision becomes less about age alone and more about overall health, previous screening results, family history, genetic risk and what a woman would want to do if a test found something abnormal.
“Age alone should not determine it,” says Dr. Sujithra Jayaraj-Sudarsan, chair of the Department of Obstetrics and Gynecology at MedStar Montgomery Medical Center in Olney. “It should be a discussion between the woman and her provider.”
For women in their 60s and 70s, Jayaraj-Sudarsan says breast and colorectal cancer screening remain particularly important. Cervical cancer screening may also continue after 65, depending on previous results and risk factors.
Breast cancer screening is one area where the recommendations become less clear with age.
The U.S. Preventive Services Task Force recommends mammograms every two years for women ages 40 to 74. For women 75 and older, it says there is not enough evidence to determine whether the benefits of routine mammography outweigh the harms, leaving physicians and patients to make individual decisions.
Jayaraj-Sudarsan says she has seen women older than 75 who were denied mammogram orders simply because of their age. She has also treated active patients diagnosed with breast cancer at ages 79 and 81 whose cancers were found early.
“That stigma of 75 years old might have been appropriate two decades ago, but not anymore,” she says. “I think we need to listen to patients.”
That is where general health matters. A woman who remains active and has few serious medical problems may have more to gain from continued screening than another woman the same age whose health is declining. The decision also depends on whether finding a cancer early would be likely to change treatment or improve quality of life.
For women at higher-than-average risk of breast cancer, screening may begin earlier or include additional imaging. Jayaraj-Sudarsan says physicians look closely at family history and known genetic mutations when deciding what testing is appropriate.
Women with harmful BRCA1 or BRCA2 mutations, for example, generally begin breast screening at younger ages and may receive MRI in addition to mammography. Those mutations also increase ovarian cancer risk, although there is currently no effective routine screening test proven to detect ovarian cancer early enough to improve survival.
Colorectal cancer screening follows a similar pattern.
The U.S. Preventive Services Task Force recommends screening beginning at age 45 for average-risk adults and continuing routinely through age 75.
From ages 76 to 85, screening becomes more selective. Physicians are advised to consider overall health, previous screening history and patient preferences. Screening generally stops after 85.
Several options are available, including annual stool tests, stool DNA testing at longer intervals and colonoscopy, generally every 10 years for average-risk adults with normal results.
Jayaraj-Sudarsan says a woman who has had consistently normal colonoscopies may reasonably decide to stop screening around 75. But she does not see that age as a hard cutoff.
“If someone wants to be screened, it’s OK after discussion with the patient to continue,” she says.
Those recommendations apply to people at average risk. Someone with inflammatory bowel disease, previous polyps, a strong family history or an inherited cancer syndrome may need a different schedule.
Cervical cancer screening is another area where age 65 can create confusion.
Current American College of Obstetricians and Gynecologists guidance says routine cervical screening is not needed after 65 for average-risk women who have had adequate negative screening. That generally means a documented series of negative Pap, HPV or combined tests during the previous 10 years. Women who have not been adequately screened or who are at high risk should continue.
“We don’t stop screening for cervical cancer automatically at 65,” Jayaraj-Sudarsan says. “We go over the risk factors.”
A history of significant cervical abnormalities, for example, can change the recommendation.
More screening, however, is not always better.
Tests can produce false-positive findings, leading to more imaging, biopsies, colonoscopies or surgery even when cancer is not present. The risks of some procedures, including bleeding or perforation from colonoscopy, also increase with age.
“The main risk is more procedures and more interventions,” Jayaraj-Sudarsan says.
For an older woman with serious medical problems, the next question is what would happen after an abnormal result.
“If there is anything detected, are they willing to go through chemotherapy? Radiation may be suggested,” Jayaraj-Sudarsan says. “Is that what that particular woman wants?”
The goal is not simply to find as many abnormalities as possible. It is to find cancers when doing so is likely to improve a woman’s length or quality of life.
Family history can change the equation at virtually any age.
Jayaraj-Sudarsan says she pays close attention to histories of breast, colorectal, uterine and pancreatic cancers because certain patterns can signal an inherited cancer risk. Women who appear to be at elevated risk may be referred to a genetic counselor.
Genetic counseling can help determine whether a family history suggests an inherited cancer syndrome and whether additional testing is appropriate. It can also help women understand how a positive result might affect screening recommendations for themselves and for close relatives who may share the same risk.
For older women, knowing their own screening history is just as important.
A woman approaching 65 should know when she last had cervical screening and whether previous results were normal. Someone nearing 75 should know when she last had a mammogram or colorectal screening and whether anything abnormal was found.
Jayaraj-Sudarsan says one misconception still comes up among older patients: that reaching a certain age automatically makes cancer screening pointless.
“Most of them say, ‘The doctor says I’m too old to get the screening. There’s not much we could do at this age,’” she says. “Those are the misconceptions.”
