Cancer in the Elderly

The incidence of cancer rises among older populations [1,2] and continuous improvement in treatment outcomes is resulting in even greater increases in the prevalence of cancer survivors in this age group [3]. There is considerable variation in cancer mortality rates in the elderly among high-income countries, with the UK having poorer outcomes compared to the USA and Western and Northern European countries [4]. The diagnosis of cancer and treatment decisions following diagnosis at an older age bring specific challenges to health care providers. Further, living with cancer has specific characteristics and consequences for older people. The five papers (three from North America, two from Europe) included in this special issue address some of these topics: increasing awareness of breast cancer symptoms, management of patients with lung and breast cancers, and survivorship issues specific to older patients. There is good evidence that age is a risk factor for the delay in presentation with breast cancer [5]. L. J. L. Forbes et al. describe the implementation into routine clinical practice of an evidence-based brief intervention designed to promote earlier symptomatic presentation of breast cancer among older women. The authors have previously reported on the effectiveness of the intervention in a randomised control trial [6]; this further work shows that its introduction into routine mammography appointments at four pilot areas within the UK's Breast Screening Programme results in similar levels of breast cancer awareness among participating women (mean age 71 years, 4 months) as in the trial setting. The intervention was acceptable to women and to mammography providers. Given the low awareness of age-related cancer risk within the UK compared to a number of other countries [7], interventions of this nature, conveying key cancer messages as patients are entering the age group with highest risk of breast cancer, have the potential to contribute to earlier health seeking.