Neil Carleton studies the clinical and biological behavior of breast cancer in older populations.
Image credit:Neil Carleton, ©iStock.com, Christoph Burgstedt
Neil Carleton is a postdoctoral researcher at the University of Pittsburgh. He investigates the intersection of aging and breast cancer to develop clinical strategies for older patients. In this Postdoc Portrait interview, he explains how focusing on this under‑represented group can produce meaningful, real‑world impact.
Understanding the Aged Tumor Microenvironment
Q | What motivated you to study breast cancer in older patients?
It is an exciting blend of clinical relevance and unanswered questions, combined with tumor biology that can be explored both at the bench and in translational settings. Those elements made breast cancer a compelling focus.
As a researcher‑physician, I stay closely connected to the clinical side of these conditions. Observations in the clinic sparked my interest, especially between 2018 and 2020, when data showed that some breast‑cancer patients could forgo axillary surgery. Those findings reshaped surgical guidelines and highlighted the need to understand how age‑related breast tumors develop and behave differently.
I also find this patient population especially rewarding. Many older patients think deeply about how treatment decisions fit into their lives, and discussions about de‑escalation based on tumor biology are often reassuring and empowering.
Q | What scientific problem are you trying to solve?
I am passionate about deciphering the relationship between aging and cancer. My primary focus is breast cancer, an age‑related disease, with most women diagnosed around age 67–70. Treating this group is challenging because many have comorbidities that influence management decisions.
Clinical Impact and Surgical De‑Escalation
Q | What’s one thing you learned from your work that you didn’t expect?
I was surprised by the enthusiastic participation of older adults in our circulating tumor DNA (ctDNA) studies, which evaluate treatment de‑escalation. Although this demographic is often underrepresented in trials, many were eager to enroll and help future patients. Their motivation reinforced the importance of designing studies that actively invite older participants.
Q | If your research succeeds, what could it change for science or society?
Our prospective trials are testing new treatment paradigms for older breast‑cancer patients. Success could transform how these tumors are perceived and managed—using ctDNA as an upfront biomarker to identify candidates for surgical de‑escalation or, conversely, to pinpoint those needing more intensive therapy. Ultimately, the work aims to shift practice toward biology‑driven, personalized care for older adults.
Q | What question are you most excited to answer next?
We aim to expand our ctDNA findings to larger, more diverse cohorts and determine how best to act on the results. Patients who are ctDNA‑negative do well on endocrine therapy alone, suggesting further de‑escalation, possibly even medication discontinuation. For ctDNA‑positive patients, the key question is which intensified treatments—such as surgery or alternative regimens—offer the greatest benefit. Answering these questions will be vital for integrating ctDNA‑guided strategies into routine care.
Responses have been edited for length and clarity.