Issues in the curative therapy of breast cancer in elderly women

Approximately 20% of new breast cancer cases occur in elderly women. Treatment of these patients requires attention to several important details. Importantly, these patients often have multiple comorbidities, a different risk-benefit profile, unique social barriers to care, higher chances for treatment toxicity, and higher risks of receiving less than standard-of-care treatment. Several tools now exist to stratify risk of morbidity in elderly patients receiving cancer therapies. Modern surgical therapy carries low risks for elderly women, and breast-conserving therapy should be offered to appropriate women. Standard regimens and schedules of systemic therapy should not be withheld in elderly patients on the basis of age alone. Several developments in radiation therapy, including the acceptance of hypofractionation and accelerated partial breast irradiation in selected women with low-risk disease, offer improved convenience and access to care. Radiation therapy may be omitted in elderly women with small hormone-sensitive tumors; however, omission may be most appropriate in women aged >80 years, those with comorbidities, and those likely to be compliant with hormonal therapy.