The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under-and over-treatment. Therefore, the assessment of a patient's biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one's fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific Review

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Background Recommendations for mastectomy by multidisciplinary teams (MDTs) may contribute to variation in mastectomy rates. The primary aim of this multicentre prospective observational study was to describe current practice in MDT decision-making for recommending mastectomy. A secondary aim was to determine factors contributing to variation in mastectomy rates. Methods Consecutive patients undergoing mastectomy between 1 June 2015 and 29 February 2016 at participating units across the UK were recruited. Details of neoadjuvant systemic treatment (NST), operative and oncological data, and rationale for recommending mastectomy by MDTs were collected. Results Overall, 1776 women with breast cancer underwent 1823 mastectomies at 68 units. Mastectomy was advised by MDTs for 1402 (76·9 per cent) of these lesions. The most common reasons for advising mastectomy were large tumour to breast size ratio (530 women, 29·1 per cent) and multicentric disease (372, 20·4 per cent). In total, 202 postmenopausal women with oestrogen receptor-positive (ER+) unifocal tumours were advised mastectomy and not offered NST, owing to large tumour to breast size ratio in 173 women (85·6 per cent). Seventy-five women aged less than 70 years with human epidermal growth factor receptor 2-positive (HER2+) tumours were advised mastectomy and not offered NST, owing to large tumour to breast size ratio in 45 women (60 per cent). Conclusion Most mastectomies are advised for large tumour to breast size ratio, but there is an inconsistency in the use of NST to downsize tumours in patients with large ER+ or HER2+ cancers. The application of standardized recommendations for NST could reduce the number of mastectomies advised by MDTs.

Aim: Evaluation of early experience with implant based breast reconstruction for early breast cancer in ptotic breasts with titanium coated polypropylene mesh and lower pole dermal sling. Methods: A pilot prospective ongoing study where patients having immediate implant based reconstruction with non biological mesh and lower pole dermal sling are evaluated simultaneously. Patient, surgical, and tumour related factors are presented as well as the cosmetic outcome in five patients, two of whom underwent bilateral procedure for bilateral breast cancer and one who underwent simultaneous symmetrisation with reduction mammoplasty on the contralateral side. Results: All five patients had good cosmetic outcome with minor complications. There was no delay in adjuvant treatment due to complications. All were satisfied with their results and would recommend this treatment to others. Conclusion: Using a non biological mesh as well as a lower pole dermal sling, which covers the suture line and offers an extra layer of protection to the mesh, reduces the complication rate especially in patients who may be at higher risk of wound related problems such as those with increased body mass index. This procedure is also cost effective (non biological meshes are only 1/5th of the cost compared to biological meshes) and provides equivalent cosmetic outcomes in a select group of patients.

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