Breast cancer in the older population: a global challenge-an epidemiological perspective

Breast cancer is the most commonly diagnosed malignancy among women, with more than 30% of all patients being over 70 years at the time of diagnosis. The number of older women with breast cancer is expected to increase in the upcoming decades due to the ageing of the population worldwide. Incidence and mortality rates vary between and within continents because of variances in risk factors, health care quality and screening programmes. In older patients, breast cancer occurs to the background of ageing. Ageing increases the exposure to age -related diseases resulting in a heterogeneous population with large differences in multimorbidity. Multimorbidity is associated with mortality, functional impairment, poor quality of life, high health care utilization and costs, and it challenges traditional health care systems. It is therefore essential to get a grip on an individual's fitness and frailty status. Geriatric screening tools and assessments should be used to get a general idea about these aspects. In that way, biological age, rather than chronological age, in combination with an individual's life expectancy, patient preferences and potential side effects of a treatment can be the basis of individualized treatment strategies. Nowadays, this heterogeneous older population is underrepresented in clinical trials. Future research should focus on older patients with relevant endpoints, not only in developed countries, but also in less developed countries.