Like most common cancers, breast cancer is primarily a sickness of elderly people. The median age of Americans diagnosed with breast cancer is 61 years. 41% of women diagnosed with breast cancer are ages 65 or older. The median age a breast cancer patient dies is 68 years, and 57% of deaths from this disease occur in women aged 65 and older. The disease is often curable when in the early stages in both older and younger adults. An estimated 1.5 million American women over 65 years of age are breast cancer survivors, and more than 820,000 of these survivors are 75 years of age or older.
The incidence and mortality risk of breast cancer is higher as one becomes older. Both the likelihood of developing breast cancer and dying from the disease are higher in seniors than in younger adults. Women in the oldest ages (ages 85 and over) are an estimated three times more likely to have breast cancer compared with the youngest adults (ages 40 to 44). Their mortality rate is also 13 times greater.
There is sound evidence that treatment patterns between older and younger women with breast cancer are different. A few probable reasons for these dissimilarities include other existing diseases (that are more severe than cancer or affect treatment tolerance), worse perceived or actual tolerance of treatment, worse access to care, and/or patient or physician choice.
Treatment of breast cancer essentially has a variety of modes. Women with an early stage of breast cancer usually undergo surgery. Radiation therapy can be paired with surgery to keep the disease at a local level. Options for treatment to control the systemic disease include trastuzumab (for HER2-positive disease), chemotherapy, and endocrine therapy (for disease that is hormone receptor-positive). Each of these types of treatment has certain risks and benefits to an older adult patient.
Surgical treatment for breast cancer usually involves mastectomy or breast conserving surgery (BCS, also referred to as lumpectomy). It has been recognized that age is not the most significant factor in determining one’s risk of surgery. A study has shown that even women at the oldest ages who undergo breast cancer surgery have a low risk of morbidity and mortality and can be sedated using local anesthesia if the risk of general anesthesia is overly high.
Following breast conserving surgery, women with early breast cancer commonly undergo radiation therapy to the preserved breast. When used simultaneously with whole-breast radiation, breast conserving surgery has the same survival as mastectomy alone. Older adult women seem to tolerate radiation therapy well, although some women with poor functional status, comorbid pulmonary or cardiac disease, or impaired cognition may have less tolerance to radiation.
A variety of types of systemic therapy are used in early stages of breast cancer that include targeted therapy with trastuzumab, cytotoxic chemotherapy, endocrine therapy, or some combinations of these.
Due to the prevalence of breast cancer among older adult women, early intervention and individualizing treatment options is critical. Generally, elderly women can tolerate most of the same forms of treatment for early breast cancer as well as younger women, but extra consideration must be given to preexisting conditions, life expectancy, and other factors that might be significant. The short-term and long-term results of cancer treatments should be considered, and appropriate screening and resources for these toxicities are crucial.