Breast Cancer in the Elderly

Abstract

Elderly patients with breast cancer are more likely to present with more favorable tumor characteristics and molecular subtypes; however, outcomes are worse, with lower survival rates compared with younger women. Less use of screening, undertreatment, the frequency of comorbidities, and the lack of information in clinical trials on the use of systemic therapy in this population all likely play a role. Unless patients have a prohibitive risk for surgery or a life expectancy less than 5 years, surgery should be considered for elderly patients who are surgically resectable. Radiation and chemotherapy are less likely to be used in elderly patients; however, with an increase in the use of neoadjuvant therapy for breast cancer patients, recommendations or guidelines for neoadjuvant therapy for the elderly are needed. Further tools that can assist physicians with risk assessment of elderly patients for both surgery and adjuvant therapies are needed. A multidisciplinary discussion that includes discussion of the need for adjuvant therapy is necessary and should be balanced against the patient’s comorbidities and functional status when deciding on the best course of treatment for these patients. It should be emphasized that elderly patients should be offered standard treatments that nonelderly patients receive, and these recommendations should only be modified if there is limited life expectancy or other socioeconomic factors that influence whether patients can undergo standard treatments. This review contains 2 figures, 11 tables, and 60 references Key words: breast surgery, breast cancer in the elderly, elderly breast surgery, elderly oncology, geriatric breast surgery