EBCC-15 manifesto: Removing age-related barriers to improve equity in breast cancer care.

The 2026 European Breast Cancer Conference (EBCC)-15 manifesto provides recommendations aiming to overcome age-related barriers across all stages of the breast cancer pathway (screening, diagnosis, treatment and follow-up). Practical solutions can help to overcome some of the physical and logistical barriers to screening and diagnosis (e.g. out-of-hours and mobile diagnostic services) and clinical trial participation (e.g. patient-centred trial design, reduced complexity and bureaucracy, flexible scheduling, geriatric assessment, age-appropriate physical, psychological and technological support and educational resources). Pragmatic trials should be co-designed with patients and their advocacy groups to address the specific needs of younger and older individuals and fill gaps in our knowledge and understanding (e.g. risk-stratified screening, impact of treatment on reproductive and sexual health, dose optimisation of locoregional and systemic therapy) to avoid under- and over-treatment, adjusting for age-specific needs. Communication training improvements for all healthcare professionals should consider differing age-related priorities. Multidisciplinary follow-up should be tailored to age-related priorities and frailty during and after treatment, including rehabilitation, social and employment support and the right to be forgotten. Decision-making at every stage from screening to post-treatment follow-up should be guided by estimating individual risk rather than by chronological age. Integrating these recommendations into all aspects of care will allow us to offer women with breast cancer the best possible experience and outlook according to each individual's priorities, regardless of their age. More broadly, many of these solutions may be relevant for other cancers with rising incidence in younger and older adults, such as colorectal cancer.