There is insufficient evidence to determine the benefits and harms of screening mammography for women aged 75 and older. Therefore, guidelines emphasize on shared decision-making. This study aimed to understand older women’s mammography screening decision, physician’s role in their decision, and their willingness to discontinue screening. Using stratified sampling based on age (70–74 vs. 75+), race/ethnicity (Non-Hispanic Blacks, Hispanics, Non-Hispanic Whites) and education (≤high school vs. >high school), fifty-six older women with no breast cancer history participated in semi-structured interviews to discuss their decision-making process and preferences for screening. Iterative, comparative thematic analyses revealed that the majority of the older women desired to continue screening. Women aged 75+ tended to discontinue, whereas those aged 70–74 tended to continue screening. Seventy-seven percent of the older women stated that their physician initiated the discussion regarding continuing/discontinuing screening, whereas 18% initiated the discussion, 1% were influenced by a relative and only 4% stated involvement in shared decision-making, describing the process as a ‘mutual thing between us’ or ‘both [of us].’ Most women followed their physician’s recommendations for screening. Nearly 80% of those continuing mammography had no personal desire to stop, even for those aged 75+ (38%). Some of the reasons why a continuer may discontinue mammography screening were health, physician recommendation, harms, evidence or beyond the age of 80. This study suggests a need for improved communication between physicians and older women regarding the benefits and harms associated with mammography screening.