Age-related survival gaps in triple-negative breast cancer: a 10-year real-world analysis

Triple-negative breast cancer (TNBC) is characterized by aggressive biological behavior and poor prognosis. While multimodal treatment is standard, it is frequently withheld from older adults. We evaluated age-related gaps in diagnosis, treatment, and survival, testing whether disparities in clinical management drive worse outcomes in older adults. This 10-year retrospective cohort study (2010-2019) included 289 TNBC patients stratified into three age groups (≤ 45, 46-69 and ≥ 70 years). Clinicopathological features, treatment patterns, adherence to the ESMO-defined standard of care (SOC), and 5-year survival were analyzed. TNBC incidence (10.8%) remained consistent across age groups (p = 0.374). Patients aged ≥ 70 years presented with larger tumors (median: 27 mm; p = 0.003) and received less intensive diagnostic workups (p < 0.001). SOC adherence was significantly lower in older adults (50.9% vs. 85.9% in those ≤ 45 years; p < 0.001). SOC nonadherence increased the risk for both overall mortality (OM) (HR: 3.47) and breast cancer-specific mortality (BCSM) (sHR: 2.88) (p < 0.001). Failure to achieve pathologic complete response (pCR) tripled mortality risk (OM HR: 3.74, p = 0.016; BCSM sHR: 3.54, p = 0.018). Older women had lower survival rates than did those aged 46-69 years for both 5-year overall (56.0% vs. 83.0%; p < 0.001) and breast cancer-specific survival (63.0% vs. 85.0%; p = 0.006). The poorer prognosis in older adults with TNBC is significantly associated with clinical management disparities and low SOC adherence, while histopathological markers of tumor aggressiveness remain highly prevalent across the age spectrum. Daily practice must transition from chronological age-based decisions toward biological fitness to overcome ageism, avoid undertreatment, and ensure personalized therapeutic decision-making.