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Breast Cancer in the Elderly

Diana Crivellari, Matti Aapro, Robert Leonard, Gunter von Minckwitz, Etienne Brain, Aron Goldhirsch, Andrea Veronesi, Hyman Muss

From the Division of Medical Oncology C, Centro di Riferimento Oncologico National Cancer Institute, Aviano; European Institute of Oncology, Milan, Italy; Doyen Clinique de Genolier, Geneva, Switzerland; South West Wales Cancer Institute, Swansea University Medical School, Swansea, United Kingdom; German Breast Group, Neu-Isenburg, Germany; Department of Medical Oncology, René Huguenin Cancer Centre, Saint-Cloud, France; and the Vermont Cancer Center, University of Vermont College of Medicine, Burlington, VT

Address reprint requests to Diana Crivellari, MD, Division of Medical Oncology C, Centro di Riferimento Oncologico National Cancer Institute, 33081 Aviano (PN) Italy; e-mail: dcrivellari{at}cro.it

Screening and adjuvant postoperative therapies have increased survival among women with breast cancer. These tools are seldom applied in elderly patients, although the usually reported incidence of breast cancer is close to 50% in women 65 years or older, reaching 47% after 70 years in the updated Surveillance, Epidemiology, and End Results (SEER) database. Elderly breast cancer patients, even if in good medical health, were frequently excluded from adjuvant clinical trials. Women age 70 years who are fit actually have a median life expectancy of 15.5 years, ie, half of them will live much longer and will remain exposed for enough time to the potentially preventable risks of a relapse and specific death. In the last few years, a new concern about this issue has developed. Treatment now faces two major end points, as in younger women: to improve disease-free survival in the early stages, and to palliate symptoms in advanced disease. However, in both settings, the absolute benefit of treatment is critical because protecting quality of life and all its related aspects (especially functional status and independence), is crucial in older persons who have more limited life expectancy. Furthermore, the new hormonal compounds (aromatase inhibitors) and chemotherapeutic drugs (capecitabine, liposomal doxorubicin), are potentially less toxic than and equally as effective as older more established therapies. These new treatments bring new challenges including higher cost, and defining their benefit in elderly breast cancer must include an analysis of the cost/benefit ratio. These issues emphasize the urgent need to develop and support clinical trials for this older population of breast cancer patients both in the adjuvant and metastatic settings, a move that will take us from a prejudiced, age-based medicine to an evidence-based medicine.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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