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 and is a substantial part of routine oncology practice. However, management of breast cancer in this population is challenging because the disease is highly heterogeneous and there is insufficient evidence specific to older adults. Decision making should not be driven by age alone but should involve geriatric assessments plus careful consideration of life expectancy, competing risks of mortality, and patient preferences. A multidisciplinary taskforce, including members of the European Society of Breast Cancer Specialists and International Society of Geriatric Oncology, 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 guidelines were expanded to include chemotherapy toxicity prediction calculators, cultural and social considerations, surveillance imaging, genetic screening, gene expression profiles, neoadjuvant systemic treatment options, bone-modifying drugs, 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.
Competing Interests: Declaration of interests LB reports personal fees from AstraZeneca, Eisai, Lilly, Pierre Fabre, and Daiichi Sankyo; grants, personal fees, and non-financial support from Celgene, Ipsen, and Pfizer; grants and personal fees from Genomic Health and Novartis; and personal fees and non-financial support from Roche, outside the submitted work. NLMB reports grants and personal fees from Pfizer and grants from Genomic Health, outside the submitted work. HW reports that his institution (University Hospitals Leuven, Leuven, Belgium) received consulting fees and honoraria from AstraZeneca, Biocartis, Lilly, Novartis, Pfizer, PUMA Biotechnology, Roche, Sirtex, and Daiiji; the institution received unrestricted research grants from Roche and Novartis; and HW received travel support from Roche and Pfizer. MSA reports personal fees and non-financial support from the Multinational Association for Supportive Care in Cancer, European Society of Medical Oncology, and European CanCer Organisation; grants and personal fees from Helsinn, Sandoz; and personal fees from Tesaro, Merck, Vifor, Pfizer, Taiho, and Kyowa Kirin, outside the submitted work. EGCB reports personal fees from Pfizer, Roche, Samsung, Pierre Fabre, Novartis, AstraZeneca, TLC PharmaChem, Clinigen, Mylan, and G1 Therapeutics; and grants and personal fees from Bristol Myers Squibb, outside the submitted work. All other authors declare no competing interests.
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