# Updates and Future Directions for the Nottingham Research Programme on Primary Breast Cancer in Older Women

## TL;DR

This paper updates the Nottingham research on breast cancer in older women, focusing on biology, psycho-social factors, and treatment cost-effectiveness.

## Contribution

The paper outlines unique research on biological, psycho-social, and economic aspects of breast cancer in older women, a population with limited evidence-based guidelines.

## Key findings

- The Nottingham programme is the only reported initiative focusing on primary breast cancer in older women.
- The research highlights the need for age-specific guidelines due to the low level of evidence for older women.
- Key studies focus on biological differences, psycho-social factors, and cost-effectiveness of treatment strategies in older women.

## Abstract

The Nottingham programme on primary breast cancer in older women is a unique resource, appearing to be the only one of its kind reported in the literature. In this update, we will describe the background to this subject, the main findings from the research team to date, focusing on biology, psycho-social aspects, and cost-effectiveness of different treatment modalities in this cohort, and directions for future research in this field.

The global population is ageing and the risk of breast cancer increases with age. Therefore, we can expect an increase in the number of cases of breast cancer worldwide in the next 20 years. Currently, there are few age-specific guidelines for the management of breast cancer in older women. The International Society of Geriatric Oncology and European Society of Breast Cancer guidelines on this topic were last updated in 2021 and provide some recommendations, although it is worth noting that, generally, the level of evidence pertaining to older women is low. The Nottingham research team on older women with primary breast cancer is working on three main aims in this cohort: (1) understand the unique biological differences between breast cancer in older compared to younger women, (2) explore the unique psycho-social factors that may be present in this population and differ from those found in younger women, as well as how this may influence treatment decisions, and (3) the cost-effectiveness of various treatment strategies in this cohort. This paper will outline key studies published by the Nottingham team in these areas to gather data and highlight future directions for the research group.