Management of Primary Breast Cancer in Older Patients: Treatment Options

Age-related differences occur in the biology of breast cancer. Elderly patients have breast cancers that are more likely to be well differentiated, to have slower growth rates, and to be endocrine responsive. In elderly patients, primary breast cancers can frequently be treated by breast conserving surgery. Radiation therapy may be necessary less often after breast conserving surgery, and there is less rationale for prophylactic axillary dissection. Since elderly patients have been systematically excluded from randomized clinical trials, our data on breast cancer management has a less firm scientific basis than for younger patients. The available data suggest age should be only one consideration in selection of treatment, and to determine optimum therapy, age should not be a criterion to exclude patients from trials.