Breast cancer in elderly patients

Very little has been reported on the natural history of breast cancer in the very old. It is often assumed that tumors in this age group are less virulent, and that other diseases associated with aging may take priority in affecting life and health. Moreover, therapy may be more harmful and may provide less benefit to elderly breast cancer patients. Clearly, data on the natural course of breast cancer and outcome of therapy in this population are needed.
In our work we retrospectively reviewed the charts and obtained complete follow-up of 135 women diagnosed with localized breast cancer at age 80 years or older, who received standard (L +AXLND followed by XRT or MRM = SLT) or less than standard local treatment in 2 tertiary centers in Israel between 1991 and 2001.
The median age at diagnosis was 83 years. The majority of the patients (56%) received less than standard local treatment (SLT).  At a median of 70 months from diagnosis, recurrence of breast cancer was documented in 18 patients, or 13.3% of the study group and only 25% of the patients had died. The number of locoregional recurrences was equally divided between the patients who received SLT and those who received less than SLT. However, axillary recurrences were detected only in the less-than-SLT group (no axillary treatment). Locoregional recurrence, overall, was detected in 12 patients, 11 of whom did not get radiotherapy as part of their first-line therapy. There was no difference in disease specific and overall mortality between the 2 groups.
Tumors histology, grade, receptor positivity and the rate of axillary lymph node involvement were similar to those reported for postmenopausal breast cancer in general and did not support the assumption that breast tumors are more indolent in elderly patients. We concluded that less than SLT might be applied in this age group, with awareness of the risk of axillary failure.
Old age should not be the only factor in selection of therapy for these patients. Possibly, the sentinel node technique may help reduce the disturbing increase in axillary failures.

Bibliographical reference:

Evron E et al.: "Breast cancer in octogenarians", Cancer. 2006 Apr 15;106(8):1664-8

Ella Evron

Institute of Oncology, Assaf Harofeh Medical Center, Zerifin, Israel