Breast disease in elderly women

Area of Science:

• Oncology
• Geriatric Medicine
• Public Health

Background:

• Breast cancer incidence and mortality rise with age, yet screening is underutilized in older women.
• Elderly women with comorbidities can still benefit from screening mammography, reducing mortality.
• Local breast cancer therapies, including mastectomy and breast-conserving surgery with radiotherapy, are generally well-tolerated in older populations.

Purpose of the Study:

• To review the current understanding of breast cancer management in elderly women.
• To highlight the underutilization of screening and treatment in this demographic.
• To emphasize personalized treatment approaches based on physiological status.

Main Methods:

• Review of existing studies on breast cancer screening and treatment in elderly women.
• Analysis of the efficacy and tolerability of various therapeutic options, including surgery, radiotherapy, and pharmacotherapy (tamoxifen, chemotherapy).
• Discussion of factors influencing treatment decisions, such as comorbidities and patient preferences.

Main Results:

• Mastectomy offers excellent local control with low operative mortality in women over 65, but no survival advantage over lumpectomy plus radiotherapy.
• Radiotherapy is crucial for local control in breast-conserving therapy and is well-tolerated regardless of age.
• Tamoxifen can be an effective alternative to surgery for elderly women with severe comorbidities, achieving significant response rates.

Conclusions:

• Breast cancer in older women is not an indolent disease and carries significant mortality.
• Underutilization of indicated adjuvant therapies is a common problem in elderly breast cancer management.
• Treatment decisions for older women should be individualized, considering physiologic age and patient needs, not solely chronological age.