Management of elderly patients with breast cancer: the time for surgery

Most patients with breast cancer are likely to benefit from local treatment (surgery and/or radiotherapy). Historically an arbitrary cut-off of 70 years has been widely used, above which women were considered for tamoxifen-only treatment. We looked at the proportion of our patients who did not have early surgery for breast cancer to see if this cut-off might have been used too rigidly, resulting in suboptimal treatment of some patients over 70 years of age. A step change in the rate of surgical treatment around age 70 was sought as evidence.

A total of 2209 consecutive patients with confirmed histological diagnosis of breast cancer were identified; 677 of these did not have surgery within 3 months of diagnosis. Analysis determined age group distribution and the reasons for no surgery or delayed surgery.

A step increase in the number of patients not undergoing early surgery was clearly seen at 70 years of age.

Age may have been used too rigidly to decide local treatment for elderly patients with breast cancer. Comprehensive multidisciplinary assessment is needed to make informed decisions and to optimize management of elderly patients.