Authors:

Alberto Costa

,

Lynda Wyld

Date of publication: 22 December 2025
Last update: 22 December 2025

Abstract

This abstract summarizes an interview with Professor Lynda Wyld, Chief Investigator of the Bridging the Age Gap in Breast Cancer study, conducted by Dr. Alberto Costa. The study, launched in the UK in 2012, aimed to address the lack of evidence for treatment decisions in women aged 70 and older with operable breast cancer. Nearly 3,500 patients were recruited across 56 breast units, and detailed data on fitness, tumor characteristics, and outcomes were collected. Key findings indicate that surgery remains the preferred option for most women over 70, as it was associated with lower all-cause and breast cancer-specific mortality compared to primary endocrine therapy (PET). However, after adjusting for age and health status, survival differences narrowed, suggesting PET may be appropriate for very elderly or frail patients. Chemotherapy reduced metastatic recurrence risk in high-risk, fit patients, but survival benefits were limited to those with ER-negative tumors. Importantly, aggressive treatments negatively impacted quality of life, though these effects were largely transient. A major output of the project was the development of the Age Gap Decision Tool, an online resource that predicts outcomes based on age, fitness, and tumor biology. The tool improved patient knowledge and influenced treatment choices, often toward more conservative options. Its adoption has extended internationally, with ongoing efforts to incorporate quality-of-life metrics. The study highlights the need for individualized treatment strategies to avoid over- and under-treatment in older women, supported by evidence-based decision aids.

Article

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Acknowledgement

The article was published in Cancer World, Issue 91-95 Spring - Summer 2022

We would like to thank the editor for kindly granting permission to republish the article.