Rethinking Breast Cancer Care and Treatment for Older Adults
- Older women face significantly higher risks of breast cancer, with nearly half of all diagnoses occurring in patients aged 65 or older and about 20% in those 75...
- The exclusion of older patients from clinical research creates substantial gaps in evidence-based care.
- Work by the Cancer and Aging Research Group, co-authored by Rachel A.
Older women face significantly higher risks of breast cancer, with nearly half of all diagnoses occurring in patients aged 65 or older and about 20% in those 75 and older, yet clinical trials frequently exclude this demographic. Only 9% of participants in breast cancer trials are 65 or older, leaving physicians with limited data on how drugs behave in older adults and fewer standardized treatment guidelines.
Clinical trials and research gaps for older adults
The exclusion of older patients from clinical research creates substantial gaps in evidence-based care. Dedicated research programs and clinical trials are essential to uncover how breast cancer manifests differently in older people and to address under-studied issues within this age group.
Work by the Cancer and Aging Research Group, co-authored by Rachel A. Freedman, produced a predictive tool for severe chemotherapy side effects in older breast cancer patients. Evaluating overall health profiles enables clinicians to anticipate adverse reactions and provide better supportive care.
Biology prompts physicians to rethink biopsy recommendations
Breast tumors develop and grow differently in older patients due to varying hormone levels and inflammation. Neil Carleton, a cancer biologist and first-year resident physician at Brigham and Women’s Hospital, stated that breast cancer is a heterogeneous disease.
To address this clinical inertia, researchers implemented a nudge to remind providers to consider omitting the biopsy. One surgeon, when surveyed, said that the nudge “did exactly what its job was,” urging physicians to think about biology rather than reflexively recommending the biopsy.
Investigating estrogen enzymes and circulating tumor DNA
Carleton and his colleagues investigated why most breast cancer cases in older women remain estrogen-receptor positive despite lower circulating postmenopausal estrogen levels.
Laboratory models showed that targeting the process they identified could offer a potential therapeutic intervention for future treatments administered via gels or patches with fewer side effects than current inhibitors. Researchers also explored primary endocrine therapy as an alternative to surgery for women aged 70 and older, noting that only 3% died of breast cancer after six years.
To monitor patients who forgo surgery, Carleton uncovered a way in September 2021 to potentially track disease, which could include regular imaging or ctDNA tests.