Locally advanced breast cancer in octogenarian women

Specific Aspects of Breast Cancer Therapy of Elderly Women

Breast cancer is the leading cause of death among women, and its incidence increases with age. The average age at diagnosis is 61 years, and the majority of deaths occurs after the age of 65 years. Optimal approach to elderly women with breast cancer is still a major challenge. Elderly patients with cancer should have at least a brief geriatric assessment to detect potentially treatable problems not always adequately evaluated by the oncologists. Therapeutic nihilism should be avoided and effective treatment provided, unless there are compelling reasons against it. Sharing the care for the patient with geriatricians or primary care physicians trained in geriatrics should be considered for all vulnerable and frail elderly patients.

Breast cancer in the elderly

Breast cancer is the most commonly diagnosed cancer in women and most breast cancers are not attributable to risk factors other than female gender and increased age. However, despite its increasing prevalence in the geriatric population, prospective clinical trials for older cancer patients do not exist and most data come from retrospective studies or subanalyses from general population studies. As a result physician's, patient's and family members' fear predominates and elderly patients do not receive the appropriate treatment when compared with younger ones. Treatment is offered according to biological age alone and life expectancy, comorbidity and functional status are not considered when deciding treatment strategy. Surgery is often denied to patients older than 70 years of age, radiotherapy and chemotherapy are omitted due to the fear of toxicity and hormonal therapy, even though it represents a great tool as adjuvant therapy, it is associated with significant morbidity when chosen as primary treatment. Palliation of symptoms remains the main goal for metastatic disease but for the rest of the patients improving disease-free survival in the early stages should guide therapy no matter chronological age.

Treatment of breast cancer in older women

BACKGROUND

Breast carcinoma management in the elderly often differs from the management in younger women and there is considerable controversy about what constitutes appropriate cancer care for older women. This controversy is reflected in the persistence of age-dependent variations in care over time, with older women being less likely to receive definitive care for breast cancer. There has been a significant increase in the last years in the number of studies conducted in older patients with breast cancer. Although available age-specific clinical trials data demonstrate that treatment efficacy is not modified by age, this evidence is limited by the lack of inclusion of substantial numbers of older women, particularly those of advanced age and those with comorbidities.

METHOD

The literature-based evidence of the last 10 years was extensively reviewed on the main issues concerning the treatment of breast cancer in older women.

RESULTS

Surgical treatment in older patients has evolved from avoidance to mastectomy to breast-conserving surgery, similarly to younger patients. Given its negative effect on the quality of life, in the last few years the role of adjuvant radiotherapy has been questioned in elderly patients with breast cancer. Adjuvant chemotherapy benefit in older patients applies mainly to Estrogen-receptor-negative patients, while in Estrogen-receptor-positive patients a major role is played by endocrine treatment. New "elderly-friendly" drugs, that can help clinicians to reduce toxicity, are now available for breast cancer.

Breast cancer in octogenarians

BACKGROUND

The number of older cancer patients has increased in recent years. Guidelines for their care are often lacking. Data on the natural course of breast cancer and outcome of therapy in this population are needed.

METHODS

The authors undertook a retrospective chart review with complete follow-up of 135 women diagnosed with localized breast cancer at age 80 years or older, who received standard or less than standard local treatment in 2 tertiary centers in Israel between 1991 and 2001.

RESULTS

Median age at diagnosis was 83 years. In 60 (44%) patients, initial local treatment consisted of modified radical mastectomy or lumpectomy and axillary dissection followed by radiation therapy [standard local treatment (SLT)]; 75 (56%) patients received less than SLT. Tumors were stage T1-T2 in 90% of cases, 76% of the tumors were hormone-sensitive. Infiltrating duct carcinoma predominated (90 cases), mostly (80 of 90) Grade 2-3. Lymph node metastases were detected in 32 of 73 (44%) patients who underwent axillary lymph node dissection. At a median of 70 months after diagnosis, 18 (13%) patients had disease recurrence, and 34 (25%) had died. Axillary failures were detected only in the less-than-SLT group. This did not indicate worse overall or disease-specific survival.

CONCLUSION

Most breast cancer octogenarians in this series lived > 6 years after diagnosis. These data do not support the assumption that breast tumors are histologically more indolent in elderly patients. Less than SLT can be applied to this patient group with somewhat increased axillary failure rates that may be addressed upfront by the sentinel node technique.