Breast Cancer in the Older Woman: Therapeutic Controversies

This article reviews several controversial issues related to treatment of in situ, localized, locally advanced, and metastatic breast cancer in the elderly. In particular we examine the management of both ductal and lobular carcinoma in situ, the benefits of breast preservation, the indications for postoperative irradiation following partial mastectomy, the role of axillary lymphadenectomy in patients with a clinically normal axilla, and the value of systemic treatment for localized breast cancer. In addition, we review the indications for and duration of adjuvant hormonal treatment with tamoxifen and adjuvant cytotoxic chemotherapy, neoadjuvant systemic therapy for locally advanced breast cancer, and approaches to the palliation of metastatic disease.