Breast Cancer Awareness Month: Screening Advice for Women Over 65

Many women over 65 reach a point where they wonder whether they still need mammograms, and how often. October, Breast Cancer Awareness Month, is a sensible time to settle the question. The honest answer depends on your age, your health and your own preferences, and the major medical groups don’t all agree.

What follows is what the current national recommendations say for women 65 to 74 and for women 75 and older, what Medicare pays for, and how to get a useful conversation going with your doctor.

Why screening still matters after 65

Breast cancer is mostly a disease of middle-aged and older women. According to the American Cancer Society, the median age at diagnosis is 63, so half of all women diagnosed are older than that. The Society estimates that about 321,910 women in the United States will be diagnosed with invasive breast cancer in 2026, and about 42,140 women will die from it.

A screening mammogram is an X-ray of the breast. It can find cancer before it’s big enough to feel or to cause symptoms, and catching it early often means more treatment choices.

Screening has downsides, too. Mammograms can lead to false alarms, extra tests and biopsies, and sometimes to treating slow-growing cancers that would never have caused harm. That trade-off is why age and overall health belong in the decision.

What the U.S. Preventive Services Task Force recommends

The U.S. Preventive Services Task Force (USPSTF) is an independent panel of experts, and many doctors follow its lead. Its current breast cancer screening recommendation came out on April 30, 2024.

Women 40 to 74: every two years

The Task Force recommends a screening mammogram every two years for women ages 40 to 74 who are at average risk. It gave this a “B” grade, meaning the panel found at least a moderate net benefit.

Why every two years instead of every year? In the panel’s review, biennial screening struck a better balance of benefits and harms. Modeling showed that yearly screening leads to more false-positive results and more overdiagnosis.

Women 75 and older: not enough evidence either way

For women 75 and older, the Task Force issued an “I” statement, for insufficient evidence. No randomized trials included women this age. Computer modeling suggests some benefit, but another analysis found none for women ages 75 to 84.

An “I” statement isn’t a recommendation against screening. The Task Force leaves it to clinicians’ judgment, which in practice makes it a personal decision you work out with your doctor.

Who these recommendations leave out

The guidance is for women at average risk. It doesn’t apply if you’ve had breast cancer before, had a high-risk breast lesion found on an earlier biopsy, carry a high-risk gene change such as BRCA1 or BRCA2, or had high-dose chest radiation at a young age. Women in those groups should follow a plan set with their own care team.

The American Cancer Society’s view

The American Cancer Society (ACS) has its own guideline for women at average risk. At 55 and older, it says, women can switch to a mammogram every other year or keep going yearly.

ACS doesn’t set a stopping age. Screening should continue as long as a woman is in good health and expected to live at least 10 more years. Other professional groups also tie the decision to overall health and life expectancy rather than age alone.

What Medicare covers

Medicare Part B pays for breast cancer screening with no upper age limit.

• Screening mammograms: once every 12 months for women 40 and older. You pay nothing for the test if your provider accepts assignment.
• Diagnostic mammograms: covered more often than once a year when medically necessary, for instance when a screening mammogram turns up something that needs a closer look. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.
• Breast ultrasounds: covered only when medically necessary and ordered by your doctor or other provider.

In a Medicare Advantage Plan, yearly screening mammograms don’t need a referral. Ask your plan which imaging centers are in its network.

Questions to bring to your doctor

Because the guidance for older women leaves room for choice, a short conversation goes a long way. You might ask:

1. Based on my health and family history, am I at average risk or higher risk?
2. How has my screening gone in the past, and when was my last mammogram?
3. If you found an early cancer, would treatment make sense for me given my other health conditions?
4. Should I screen every year or every two years?
5. My report says my breasts are dense. Does that change anything for me?

About that last one. Since September 10, 2024, federal rules have required every mammography facility to tell patients in their results letter whether their breast tissue is dense or not dense. Dense tissue can make cancer harder to spot on a mammogram. The Task Force found there isn’t yet enough evidence to recommend for or against extra tests such as ultrasound or MRI for women with dense breasts, so ask your doctor what makes sense in your case.

For a broader list of check-ups, see our guide to health screenings for seniors by age and our list of questions to ask your doctor.

Warning signs to watch for at any age

Even if you decide to stop having mammograms, keep an eye on changes in your breasts. The American Cancer Society lists these possible signs:

• A new lump or mass in the breast or underarm
• Swelling of all or part of a breast
• Skin dimpling, sometimes looking like an orange peel
• Red, dry, flaking or thickened skin on the breast or nipple
• Breast or nipple pain
• A nipple that turns inward
• Nipple discharge other than breast milk
• Swollen lymph nodes under the arm or near the collarbone

Most breast changes aren’t cancer. Still, have a health care professional check any new lump or change.

Two women, two reasonable choices

No single answer fits every woman over 65. A healthy, active 76-year-old may choose to keep screening. A woman with serious health problems may decide the tests are more burden than benefit. Both are reasonable when they’re made with good information.

Your senior center may be able to help. Some host health talks in October or can arrange rides to imaging appointments. Our senior center directory lists centers near you.

This article is general information, not medical advice. Talk with your doctor or nurse practitioner about your personal risk and screening plan.

Where to learn more

• USPSTF: Breast Cancer Screening recommendation
• Medicare.gov: Mammogram coverage
• American Cancer Society screening recommendations
• CDC: Breast cancer screening
• FDA: Breast density notification rule