American women have a 12 percent lifetime risk of being diagnosed with breast cancer, the second most common cancer in women, according to the American Cancer Society. While young women do get breast cancer, the disease is much more common in women aged 60 and older.
Rachel Freedman, MD, MPH, a medical oncologist at the Susan F. Smith Center for Women’s Cancers at Dana-Farber and medical director of the Program for Older Adults with Breast Cancer (OABC), explains what older adults should know about breast cancer:
There are many factors that can impact breast cancer risk.
The reasons people develop breast cancer are often not known, with a small proportion of diagnoses occurring in people with a hereditary predisposition to breast cancer. In general, the risk of breast cancer increases with age and estrogen exposure, including the age at which a person starts having periods, whether and when she becomes pregnant, and when she enters menopause.
Black women are not at higher risk of breast cancer over the course of a lifetime compared to white women, but young Black women are at a higher risk of breast cancer before the age of 50.
Start mammography earlier.
According to the American Cancer Society, women who are not at an elevated risk of breast cancer (i.e., do not have a family history or certain genetic mutations) are recommended to have mammograms annually starting at age 40.
Other guideline societies, such as the United States Preventative Taskforce (USPTF), had previously recommended having screening mammograms every 1-2 years starting at age 50 for average-risk women. Recommendations between ages 40 and 50 were intended to be preference and risk based.
However, in 2024, the USPTF has updated their guidelines to be more aligned with the American Cancer Society, with recommendations to initiate breast cancer screening at age 40 based on data suggesting that earlier screening would identify more breast cancer cases, particularly among younger Black women. Black women are 40% more likely to die from the disease compared to white women.
Breast cancer screening is also important for some LBGTQ+ people. For example, people who initiate estrogen as part of gender-affirming care might develop breast tissue. They should be screened for breast cancer after 5 years on hormones starting from age 40-45.
The age that is safe to stop routine mammograms is less clear. Older adults with serious medical issues should discuss the benefits and risks of mammography with their care providers, as it may make sense to stop mammography at some point and monitor risk through physical exams. Patients should develop a personalized plan for screening and surveillance with their doctors based on their current health and medical history.
Treatment options depend on a cancer’s features and patient preferences.
Because we can better tailor and individualize treatments, most people with breast cancers that are estrogen-sensitive do not require chemotherapy. Surgery, radiation, and medication treatments remain important to consider, but recommendations depend on a person’s cancer stage, tumor features, subtype, safety concerns, overall health, and preferences.
Early-stage cancers with very low risk for recurrence will often not require the same approach as cancers with a higher risk for recurrence. All of these factors help medical teams recommend a treatment plan that provides benefit and minimizes harms, or side effects, of treatments.
Most older adults with breast cancer don’t die from it.
There are more deaths from breast cancer in older women simply because most diagnoses occur in older women, but most older adults with breast cancer will die from a cause other than their breast cancer. Breast cancer survival rates, for people of any age and gender, depend on the cancer’s stage and subtype.
Anyone, regardless of age or gender, who has a family history of cancer, particularly breast and ovarian, should bring it to the attention of her physician, who can evaluate potential breast cancer risk, the need for genetic testing, and the proper screening plan to follow.
About the Medical Reviewer
Dr. Rachel Freedman is a medical oncologist and clinical researcher at DFCI in the Breast Oncology Program. In addition to seeing patients with breast cancer, her research focuses on improving the care of vulnerable patient populations who are under-represented in clinical trials and who are at risk for worse breast cancer outcomes, including older women and those who face challenges in access to care. In addition, she is interested in novel therapeutics, serving as the Principal Investigator for several clinical trials. She is also the founder and Director of the Program for Older Adults with Breast Cancer at DFCI. Dr. Freedman joined the faculty at DFCI in 2009. She studied at Georgetown University School of Medicine and obtained her master's in public health at the Harvard University T.H. Chan School of Public Health. Her research has been funded by Susan G Komen, ACS, NCI, Gateway for Cancer Research, METAvivor, and the Alliance for Clinical Trials Foundation.