Does genetic testing have any role for elderly breast cancer patients? A narrative review

Background and Objective: Hereditary breast cancer is associated with young age of onset. However, a recent study showed that the prevalence of genetic mutations in postmenopausal breast cancer patients was 3.5%, which was significantly higher when compared to 1.3% in cancer-free women. This posed the question of whether genetic testing should be extended to older patients. This literature review aimed to highlight the controversies of genetic testing for older breast cancer patients, and their subsequent management after a positive genetic test. Methods: Literature search was performed targeting published papers in English from year 2000 onwards in PubMed. Key Content and Findings: In BRCA mutation carriers, breast cancer incidence rapidly increases from early adulthood until 50 years old, then it reduced with age. Nonetheless, older BRCA mutation carriers have a higher breast cancer incidence when compared to non-carriers. The implementation of genetic testing in elderly breast cancer patients should take into account the chance of underdiagnoses, the benefits of identifying a genetic mutation and balancing it with increased medical cost and patient anxiety. Recent data suggested that BRCA1/2 mutation detection rate in postmenopausal breast cancer patients until 65 years old could be higher than what was traditionally expected, at 2%, while breast cancer patients who were 65 or above had a detection rate of about 1%. Benefits of risk-reducing contralateral mastectomy for primary breast cancer could be less in older patients due to competing causes of mortality, and a lower risk of contralateral breast cancer when compared to their younger counterparts. Conclusions: Current management guidelines for BRCA mutation carriers were based on evidence targeting younger population; there were no specific guidelines or studies targeting older mutation carriers. Individual factors such as comorbidity, competing causes of mortality, cancer risks and personal preference should all be considered when managing elderly mutation carriers. of