Breast Cancer in Older Women (70 and Over)

Why this matters for older women

Getting older is the biggest single risk factor for breast cancer. According to Cancer Research UK, around a quarter of all new breast cancer cases in the UK are diagnosed in people aged 75 and over, and most cases are diagnosed in women over the age of 50. In other words, breast cancer is very much a condition of later life, not only something that affects younger women.

Despite this, many older women believe they are past the age when breast cancer happens, or that they would be too old for treatment. Neither is true. The reassuring message is that age on its own does not decide what care you can have. What matters most is your general health and fitness, your wishes, and the kind of breast cancer you have. Many women in their 70s, 80s and beyond are treated successfully every year.

This page gives general, educational information. It is not personal medical advice. If you notice a change in your breasts, or you have questions about screening or treatment, please speak to your GP or breast care team, who can advise on your own situation.

Staying breast aware after the routine years

It is just as important to know your breasts in later life as it was when you were younger. Cancer Research UK encourages everyone to be breast aware, which simply means getting to know the usual size, shape and feel of your breasts, so you notice if something changes. There is no need to check at a set time or in a special way. The aim is to feel confident about what is normal for you.

See your GP if you notice any of the following, according to the NHS and Cancer Research UK:

• A new lump or thickening in the breast or armpit.
• A change in the size, shape or feel of a breast.
• Changes to the skin, such as dimpling, puckering or redness.
• A nipple that has become pulled in (inverted), or any change in its position or shape.
• Rash, crusting or discharge from the nipple, especially if it is bloodstained.
• Pain in the breast or armpit that does not go away.

Research highlighted by Cancer Research UK has found that older women are often less aware that breast cancer can show up as something other than a lump, and are more likely to worry about wasting their doctor's time. Please do not let either of these put you off. A breast change is exactly the kind of thing your GP wants to know about, and getting it checked early gives the best chance of simpler, more successful treatment. Most breast changes turn out not to be cancer, but it is always worth being sure.

Breast screening after the age of 70

In the UK, the NHS Breast Screening Programme invites anyone registered with a GP as female for screening (a mammogram, which is an X-ray of the breast) every 3 years between the ages of 50 and 71. According to the NHS, you receive your first invitation between the ages of 50 and 53, and your last automatic invitation is before you turn 71.

Many women assume that screening simply stops once the invitations end, but this is not the whole picture. The NHS states that if you are 71 or over, you will not automatically be invited, but you can still have breast screening every 3 years if you want to. To arrange this, you need to call your local breast screening service and ask for an appointment. This is sometimes called self-referral.

Whether to continue screening after 70 is a personal decision, and it is worth talking it over with your GP. A few things are helpful to keep in mind:

• Screening looks for cancers before they cause symptoms, so it can still pick up changes that you would not feel yourself.
• Whatever your age, you should never wait for a screening appointment if you notice a breast change. Contact your GP straight away, as screening is only for people without symptoms.
• Like any test, mammograms are not perfect. They can miss some cancers and can sometimes find changes that would never have caused harm. Your GP can help you weigh this up for your own situation.
• If you are unsure whether to book a screening appointment, your GP or local breast screening service can talk you through the pros and cons.

How treatment decisions are made

One of the most important things to understand is that there is no upper age limit for breast cancer treatment. Decisions are based on your overall health and fitness, the type and stage of the cancer, and what matters to you, rather than on your age alone. Treatment is planned by a team of specialists, often called a multidisciplinary team, and discussed with you so you can make choices together.

To help plan the safest and most effective care, the team will consider your general fitness and any other health conditions you have. For older patients, some hospitals use a more detailed assessment of fitness, sometimes called a geriatric or fitness assessment, which looks at things such as mobility, other illnesses, the medicines you take, memory and the support you have at home. This helps your team recommend treatment that is likely to do you good without causing more harm than benefit.

The main treatments for breast cancer are the same whatever your age, and may be used alone or in combination:

• Surgery, to remove the cancer. This may be breast-conserving surgery (removing the lump and some surrounding tissue) or removal of the whole breast (mastectomy).
• Radiotherapy, which uses carefully targeted radiation to lower the chance of the cancer coming back, often after surgery.
• Hormone (endocrine) therapy, such as tamoxifen or aromatase inhibitors, used for cancers that grow in response to hormones. This is taken as tablets, usually for several years.
• Chemotherapy, which uses anti-cancer drugs and is offered when the likely benefit outweighs the side effects for that person.
• Targeted and other newer drug treatments, used for certain types of breast cancer, such as HER2-positive disease.

Your team will explain which options are suitable for you and why. You can always ask what each treatment involves, what the benefits and risks are, and what would happen if you chose to have less treatment or none. These are reasonable questions, and a good team will welcome them.

The risk of not enough treatment

While it is right to avoid treatment that would do more harm than good, there is also a real concern about older women being undertreated, which means being offered less treatment than they could safely benefit from, purely because of their age. Studies in the UK have found that older women are less likely to be offered surgery and other standard treatments than younger women, even when they are fit enough to have them, and this can affect their chances of a good outcome.

For example, some older women with hormone-sensitive breast cancer are offered hormone tablets alone instead of surgery. For a frailer patient, this may be a sensible, gentler choice. But for a fit, healthy older woman, surgery is usually the more effective option, and hormone tablets alone may not control the cancer as well over time. The key point is that this should be a careful, individual decision made with you, not an assumption based on your date of birth.

Because of this, it is worth feeling able to ask questions such as: Are you offering me this because of my fitness, or because of my age? What would you recommend for a younger person in my position? It is always your right to understand your options fully and to be involved in the decision. If you would value a second opinion, you can ask your team about this too.

Managing other health conditions alongside cancer

Many older people live with one or more long-term conditions, such as heart disease, diabetes, arthritis, high blood pressure or memory problems. Having other health conditions does not mean you cannot be treated for breast cancer, but your team will take them into account when planning your care, so that treatment fits safely around the rest of your health.

Things that can help when you are managing several conditions at once include:

• Bringing a full, up-to-date list of all your medicines, including anything you buy yourself, to your appointments, so your team can check for interactions.
• Telling your cancer team about all your other conditions and the other doctors or nurses involved in your care, so everyone can work together.
• Mentioning anything that affects daily life, such as poor mobility, falls, eyesight or hearing problems, or difficulty getting to hospital, as practical support may be available.
• Bringing a family member, friend or carer to appointments to help remember information and ask questions.
• Telling your GP, who can help coordinate your overall care and support you between hospital visits.

Some breast cancer treatments can affect other parts of your health. For example, certain hormone therapies can affect bone strength, and some treatments need care if you have heart problems. Your team will monitor for this and may suggest steps to protect your bones, heart and general wellbeing during and after treatment.

Support, recovery and where to get help

Going through breast cancer at any age can be tiring and emotional, and you do not have to manage on your own. Practical and emotional support is available, and asking for it is a sign of good sense, not weakness. Help can include district nurses, occupational therapy, physiotherapy, dietitian advice, counselling, and support with transport, finances or care at home.

Trusted UK charities offer free, reliable information and helplines where you can talk things through. These include Cancer Research UK, Macmillan Cancer Support and Breast Cancer Now. Your breast care nurse is also a valuable point of contact and can answer questions, explain your treatment and point you towards local support.

At breastcancer-charity.org our mission is to improve early detection and access to care in underserved communities, where clear information and timely support can be harder to reach, and where older people are sometimes overlooked. No one should miss out on the chance of effective treatment because of their age or their circumstances. If anything here raises a question about your own health, please speak to your GP or breast care team, who know your situation best and can give advice tailored to you.