[Breast cancer in advanced age]

The incidence of breast carcinoma increases with advancing age. In view of the progressive aging of the population, this problem will tend to become more and more frequent. At present, patients of advanced age are often "undertreated" owing to the mistaken prejudice that older patients are unable to withstand standard multimodal therapy for this disease. In fact, there is no scientific evidence to that effect. Treatment choices should therefore be largely comparable to those adopted in younger patients. Even chemotherapy, which encounters the strongest resistance, by patients but also by doctors, should be administered when indicated. A number of studies have demonstrated that the toxic and side effects observed in elderly patients are comparable to those observed in younger age groups. In practice, particular attention needs to be paid when administering cytostatic treatment to patients over 80 years of age. Very conservative treatment (tamoxifen plus radiotherapy) may be reserved only to particularly frail elderly patients. In conclusion, the therapeutic choice should depend more on assessment of the biological age, life expectancy and patient's expectations than on the anagraphic age.