乳腺癌是女性最常见的癌症，随着年龄的增长，患病率显著上升。老年妇女是易感人群，患乳腺癌和死亡风险增加。然而，75岁及以上的女性被排除在所有随机对照筛查试验之外，所以关于该年龄组筛查益处和风险的最佳可用数据来自观察性研究和预测模型。老年妇女筛查的好处与年轻妇女相同：早期发现较小的低分期癌症，导致治疗方法更少侵入性和低发病率和死亡率。乳腺X线摄影检查在老年妇女中的敏感性、特异性、癌症检出率和阳性预测值要比年轻妇女显著提高，同时伴随着较低的召回率和假阳性率。过度诊断率较低，在90岁之前好处大于风险。尽管有国家和国际指南关于是否继续对超过74岁的妇女进行筛查乳腺X线摄影检查的冲突，但临床医生可以使用共享决策制定来帮助妇女做出筛查决策，并充分参与筛查过程。对于身体健康的75岁及以上妇女，继续进行每年一次的筛查乳腺X线摄影检查将挽救最多的生命。关于老年妇女筛查乳腺X线摄影检查的好处和风险的知情讨论需要包括每个女性的个体价值观、整体健康状况和并发症。本文将回顾关于75岁及以上妇女筛查乳腺X线摄影检查的好处、风险和争议，并比较国家和国际专业组织针对这一人群筛查的当前建议。© RSNA，2023此文章的测验问题可通过在线学习中心获得。

Breast cancer is the most common cancer in women, with the incidence rising substantially with age. Older women are a vulnerable population at increased risk of developing and dying from breast cancer. However, women aged 75 years and older were excluded from all randomized controlled screening trials, so the best available data regarding screening benefits and risks in this age group are from observational studies and modeling predictions. Benefits of screening in older women are the same as those in younger women: early detection of smaller lower-stage cancers, resulting in less invasive treatment and lower morbidity and mortality. Mammography performs significantly better in older women with higher sensitivity, specificity, cancer detection rate, and positive predictive values, accompanied by lower recall rates and false positives. The overdiagnosis rate is low, with benefits outweighing risks until age 90 years. Although there are conflicting national and international guidelines about whether to continue screening mammography in women beyond age 74 years, clinicians can use shared decision making to help women make decisions about screening and fully engage them in the screening process. For women aged 75 years and older in good health, continuing annual screening mammography will save the most lives. An informed discussion of the benefits and risks of screening mammography in older women needs to include each woman's individual values, overall health status, and comorbidities. This article will review the benefits, risks, and controversies surrounding screening mammography in women 75 years old and older and compare the current recommendations for screening this population from national and international professional organizations. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.