Understanding and Mitigating the Risk of Accelerated Biological Aging in Survivors of Cancer: A Scoping Review

Background Cancer and its treatments are linked to accelerated biological aging, which may contribute to late adverse health outcomes in cancer survivors. Aims This scoping review evaluated biomarker‐defined aging in adult cancer populations, focusing on associations with treatment exposures and the effectiveness of interventions intended to mitigate accelerated biological aging. Methods We searched MEDLINE, Embase, Cochrane Library, CINAHL, and Web of Science for original studies in adults (≥ 18 years) survivors of cancer. Eligible studies included a comparison group and assessed biological aging using molecular or cellular biomarkers. Retrospective studies, pediatric studies, animal or in vitro studies, and non‐biomarker‐based studies were excluded. Two reviewers independently screened studies, with discrepancies resolved by a third reviewer. Results Among 1796 records, 44 studies met inclusion criteria. Most were prospective or randomized trials from North America and Europe, predominantly in breast cancer. Treatment exposures were commonly associated with increased epigenetic age acceleration, elevated senescence markers, and altered immune profiles; the effects may be more pronounced with intensive chemotherapy. Interventional trials ( n = 15) were of heterogenous quality with only eight phase 2/3 trials, and only seven studies enrolled more than 100 participants. Nearly all were conducted in solid tumors, except for one pilot study in myeloid malignancy. Lifestyle interventions generally did not change telomere length, although one large breast cancer trial showed reduced oxidative stress. Conclusions Current evidence supports an association between cancer treatment and multiple biological aging metrics, but biomarker validity, assay heterogeneity, and residual confounding remain important limitations. Furthermore, interventional data on preventing or reversing this acceleration remains limited and heterogeneous. The lack of consistent biomarker change in many trials may reflect short follow‐up durations and small sample sizes. Research is concentrated in breast cancer and high‐income countries, highlighting the need for adequately powered trials across diverse populations to identify strategies that preserve long‐term health.