Updated recommendations regarding the management of older patients with breast cancer: a joint paper from the European Society of Breast Cancer Specialists (EUSOMA) and the International Society of Geriatric Oncology (SIOG)

Breast cancer is increasingly prevalent in older adults in the context of ongoing demographic changes and is a significant part of routine oncology practice. Nonetheless, due to its highly heterogeneous nature, management of breast cancer in this population is challenging, with the validity of the available evidence very limited for older adults. Decision-making should not be driven by age alone but involve geriatric assessments plus careful consideration of life expectancy, competing risks of mortality, and patient preferences. A multidisciplinary task force including members of the International Society of Geriatric Oncology (SIOG) and the European Society of Breast Cancer Specialists (EUSOMA) gathered to expand and update the previous 2012 evidence-based recommendations for the management of breast cancer in older individuals with the endorsement of the European Cancer Organisation. These were expanded to include chemotherapy toxicity prediction calculators, cultural and social considerations, surveillance imaging, genetic screening, genomic tools, neoadjuvant systemic treatment options, bone-modifying agents, targeted therapies and supportive care. Recommendations on geriatric assessment, ductal carcinoma in situ, screening, primary endocrine therapy, surgery, radiotherapy, adjuvant systemic therapy and secondary breast cancer were updated.