16. Breast cancer in older women

Elderly women are more likely to have less aggressive tumours, which are oestrogen receptor positive. They are less likely to be offered screening and often given inadequate treatment leading to a higher mortality rate. They should be assessed in the same way as their younger counterparts. Age should not be a consideration, rather life expectancy Patients' wishes are important but the mainstay of treatment is surgical, including axillary node clearance, with adjuvant tamoxifen as appropriate. Radiotherapy should not be withheld unless there are good reasons to contradict this. In unfit patients, tamoxifen alone is a suitable treatment but tumorectomy under local anaesthetic is preferable. If the tumour is oestrogen receptor negative, surgery and/or radiotherapy will be required.