Recommending discontinuation of breast cancer screening is appropriate in this patient. Clinical trials of screening mammography in women 75 years of age and older are not available; therefore, the survival benefit of screening mammography for breast cancer in these women is not known. Additionally, observational studies suggest a potential benefit of breast cancer screening in women 75 years of age and older only if life expectancy exceeds 10 years. In this older patient with end-stage kidney disease, life expectancy is estimated to be approximately 3 years. There are also considerable potential harms to screening, including false-positive results that lead to overtreatment and psychological distress. Because of these factors, the American Society of Nephrology, through the Choosing Wisely campaign, recommends against performing routine cancer screening in patients on dialysis with limited life expectancies and no signs or symptoms of cancer. Therefore, continuing breast cancer screening with mammography in this patient, either annually or biennially, is likely to cause harm without significant benefit, and recommending discontinuation of screening is appropriate.

Breast MRI in addition to mammography is indicated for screening only in women with a lifetime risk of breast cancer of 20% to 25% or higher as calculated by models largely dependent on family history or other clinical circumstances. The use of breast MRI would not be appropriate in this patient who is not at high risk and without a clear indication for continued screening.