Age represents a significant risk factor for breast cancer, with nearly half of diagnoses occurring in people aged 65 and older, and approximately 20% in those 75 or older. Despite this prevalence, older patients remain substantially underrepresented in clinical research, with one study finding only 9% of breast cancer trial participants were 65 or older. This gap in research participation has created challenges for physicians seeking to understand how medications and treatments function in aging populations and to develop evidence-based clinical guidance.
Neil Carleton, a cancer biologist and first-year resident physician at Brigham and Women’s Hospital, is addressing this disparity through research focused on tailored treatments for older adults with breast cancer. Carleton notes that tumors in older patients often develop and progress differently than in younger individuals due to variations in hormone levels and inflammation patterns, yet historical medical practice has applied uniform treatment protocols regardless of patient age. His work emphasizes the importance of appropriately calibrating care—which may involve either reducing or intensifying treatment—rather than assuming older adults necessarily require less aggressive approaches.
Carleton’s research has focused on a specific clinical practice: sentinel lymph node biopsies performed during tumor removal. Professional guidelines recommended against this procedure in women 70 and older with early-stage cancer, yet data from a university medical center revealed approximately 65% of qualifying patients were still receiving it, despite no survival or recurrence benefits. Working with colleagues, Carleton developed an electronic health record alert system—a simple pop-up reminder—to prompt surgeons to reconsider the procedure. Implementation across eight community clinics resulted in biopsies decreasing by almost half in the following year.
In laboratory investigations, Carleton is examining an apparent paradox in older women’s breast cancer biology. Most cases in this population are estrogen-receptor positive, meaning tumor cells respond to estrogen, yet circulating estrogen levels decline significantly after menopause. By age 85, 91% of women with breast cancer have estrogen-receptor positive disease. Carleton’s research seeks to understand how these tumors maintain growth despite lower hormonal levels, with findings potentially informing more precise treatment strategies.
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