The biology of breast cancer in older women

The incidence of breast cancer among women older than 65 years of age is 1.7 times higher than the rate for women 45 to 64 years of age, and 10 times higher than for women younger than 45. In addition, the relative survival from breast cancer is decreased among elderly women. Although elderly women more frequently present with advanced breast cancer, the incidence of other poor prognostic factors generally associated with early disease recurrence and short survival is not increased among the elderly compared to younger women. Most breast tumors from elderly patients contain estrogen receptors and progesterone receptors and would be expected to respond to hormonal therapies, and most tumors have low proliferative rates which would be indicative of slow-growing, indolent tumors. Several studies have documented that elderly women often do not receive complete workups for definitive staging of their breast cancer, and that even after adjustment for comorbid conditions, elderly patients are less likely to receive optimal standard therapy for their disease.