Breast cancer diagnosis at age 85 and older

Limited data is available on patients diagnosed with breast cancer at age 85 and older, and there is no consensus on mammographic screening guidelines for older women, including those with a history of breast cancer. We sought to describe characteristics of presentation in this patient population and to determine whether differences exist between older women with a history of breast cancer and those without.

A retrospective review was conducted of all female patients aged 85 and older who consulted a breast surgeon for a diagnosis of new or recurrent breast cancer.

From January 1, 2009 to September 30, 2024, 132 patients with newly diagnosed or recurrent breast cancer were identified. Mean age was 88.3 years (range 85-99). Ninety patients (68.2%) were diagnosed with breast cancer for the first time and the remainder (42; 31.8%) had a history of breast cancer. 57.1% of patients with a history of breast cancer were diagnosed on screening imaging compared to 31.1% with no prior history, who more commonly were diagnosed based on symptoms. In patients with a history of breast cancer, there was a mean time of 14.6 years from index cancer to ipsilateral breast tumor recurrence and 19.2 years from index cancer to contralateral cancer event.

Roughly one-third of patients had a prior breast cancer and were significantly more likely to be diagnosed on screening studies compared to women who did not have a history of breast cancer. Women without a history of breast cancer were more likely to be symptomatic at the time of diagnosis and more likely to be diagnosed at a later disease stage. In patients with a prior breast cancer, second breast cancer events tended to happen late, which raises the question of how long screening should continue after a breast cancer diagnosis in older patients and whether guidelines should distinguish between those with a prior history of breast cancer and those without.