Breast Cancer in Older Women

Abstract: Breast cancer remains the most common malignancy and the leading cause of cancer death in women of all ages. The American Cancer Society has estimated that 180,200 women will develop breast cancer in the United States in 1997 and 43,900 will die from the disease (1). Age is an important variable affecting both breast cancer biology and management. The risk of developing breast cancer increases with age. Feuer et al., using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, have estimated that the cumulative probability of developing invasive breast cancer from birth, which is less than 0.5% at the age of 40, increases approximately 20-fold for those women that reach the age of 95 years (2). As the duration of life continues to increase in the western world, the percentage of older women who have breast cancer will also increase. It is estimated that by the end of the 20th century more than 50% of all new cases of breast cancer will occur in women aged 65 years or older (3). Despite this high prevalence of disease, there is a great lack of definitive information about outcome from breast cancer in this segment of the population. Patients over the age of 65 years have frequently been excluded from large prospective randomized clinical trials, and as a consequence, no clear practice guidelines about the optimal management of these patients have been released. Many studies have indicated that elderly women with breast cancer are more likely to receive less aggressive treatment when compared to their younger counterparts (4–6). This lesser treatment has stemmed from several widely held assumptions: that older women (a) have less aggressive breast cancers, (b) have a greater likelihood of presenting with more advanced disease, (c) have a life expectancy so limited not to justify the use of standard treatment, and (d) are poor candidates for surgery more extensive than biopsy and for adjuvant treatments. Evidence to support these assumptions remains controversial. This article will provide an overview of available data on the main unresolved issues, including biology, screening, local treatment, and adjuvant therapy, and will try to indicate practice guidelines for the management of elderly women based on the current knowledge.