Conclusion

The incidence of breast cancer increases dramatically with age. Given the demographic changes occurring in the United States, the number of elderly women developing breast cancer will continue to rise. Older women as a group have more favorable prognostic factors but have lower relative survival compared with younger women. Older women have a higher likelihood of receiving nonstandard and less aggressive treatment compared to younger women, even after controlling for comorbidity. Treatment recommendations are based primarily on randomized trials of younger women. Extrapolation of these results is complicated by differences in tumor biology, host physiology, and problems common in the elderly, including comorbidity, impaired functional status, and lack of social support. Local treatment of early- stage breast cancer should be similar to that in younger women and consist of either mastectomy or breast- conserving surgery followed by breast irradiation. Most older women with hormone receptor-conserving surgery followed by breast irradiation. Most older women with hormone receptor-positive tumors should receive adjuvant tamoxifen. Some elderly patients may also benefit from adjuvant chemotherapy.

Ongoing and future study results should be instructive in determining the relative efficacy of breast irradiation in older women, as well as the benefits and toxicities of different adjuvant chemotherapeutic regimens. In elderly women with advanced breast cancer, hormonal therapy will usually be the initial treatment of choice. Chemotherapy should be considered when a patient has symptomatic hormone receptor-negative disease, extensive visceral involvement, and rapid disease progression, with particular attention to the potential risks of therapy. Most importantly, patient preferences, comorbidities, disease status, and available evidence for improvement in survival and quality of life should guide treatment of older women with breast cancer of all stages.