Optimal management of breast cancer in the elderly patient: current perspectives

Abstract

Breast cancer (BC) is the most common female malignancy in the world and almost one third of cases occur after 70 years of age. Optimal management of BC in the elderly is a real challenge and requires a multidisciplinary approach, mainly because the elderly population is heterogeneous. In this review, we describe the various possibilities of treatment for localized or metastatic BC in an aging population. We provide an overview of the comprehensive geriatric assessment, surgery, radiotherapy, and adjuvant therapy for early localized BC and of chemotherapy and targeted therapies for metastatic BC. Finally, we attempt to put into perspective the necessary balance between the expected benefits and risks, especially in the adjuvant setting.

Functional Status and Survival After Breast Cancer Surgery in Nursing Home Residents

“…Estrogen receptor positive tumors may be at least temporarily treated with endocrine therapy; for those with bulky adenopathy, radiotherapy without surgery could also be considered. 18,19 In addition to the pain and suffering reported in prior studies in younger women undergoing any breast surgery, the impact of breast cancer surgery on an even older and frailer population is likely to be even greater. For example, a qualitative study by Walter, et.…”

“…Our data do not permit analyzing outcomes by tumor subtype or stage, but multimodal therapy for breast cancer could potentially offer alternative nonsurgical treatment options. Estrogen receptor–positive tumors may be at least temporarily treated with endocrine therapy; for those with bulky adenopathy, radiotherapy without surgery could also be considered . In addition to the pain reported in prior studies in younger women undergoing any breast surgery, the consequences of breast cancer surgery in an even older and frailer population are likely to be even greater.…”

Breast cancer in women aged 75 years and older – tumour characteristics and treatment options

“…In general, advancing age is associated with reduced tolerance to physiological stress, higher prevalence of comorbidity, reduced social support, and cognitive impairment [ 8 ]. The management of BC patients requires a multidisciplinary approach [ 5 , 9 ]. In our hospital, almost all patients with BC are discussed, and an individual plan of treatment is presented for every single woman.…”

Delayed Diagnosis of Breast Cancer as a Cause of Crippling Radical Treatment of Elderly Patients

“…По данным клинического исследования, проведенного Европейской организацией исследования и лечения рака (EORTC), органосохранное хирургическое лечение в сочетании с блокаторами эстрогеновых рецепторов у пациенток пожилого возраста предпочтительнее радикальной мастэктомии. Это связано с лучшей послеоперационной реабилитацией и снижением количества осложнений, связанных с наличием сопутствующей патологии [9]. Таким образом, ошибки, допущенные на диагностическом этапе, приводящие к запоздалой постановке диагноза «рак молочной железы», приводят к более агрессивным хирургическим вмешательствам, что в значительной степени ухудшает качество и продолжительность жизни пациенток.…”