Breast Cancer Management in the Older Woman

  • Marsilio Francucci
  • Roberto Cirocchi
  • Marina Vinciguerra


Breast cancer is the most commonly diagnosed cancer as well as the leading cause of cancer death among women of all ages.

These malignant diseases diagnosed in elderly patients are often associated with more favorable biological factors, with lower aggressiveness. These features seem to be at odds with the higher incidence rates of advanced cancer diagnosed in the elderly. Because of this, there is an erroneous oncologist opinion that these “more aggressive” tumors are associated with a poor prognosis. Conversely, locally advanced tumors are often due to multiple factors including the failure to extend mammography screening to the over 70, along with a generally delayed diagnosis. This high risk of missed or delayed diagnosis is due to the reduced inclination of older women to undergo a breast assessment, even in the presence of clinical signs and symptoms.

As a result of this, older women should not be discriminated against the basis of chronological age. Prevention plays a key role here, and an extension of the age group for mammography screening is highly recommended.

A mix of Breast Units and geriatric surgery centers together carries out the most appropriate care management for each elderly patient (tailored surgery). In order to identify the most appropriate management, an accurate multidimensional evaluation of the health status and life expectancy of the patient is essential from a clinical point of view.

Surgical approach to breast cancer in elderly women should always have the same radical oncological aim, regardless of the chronological age of the patient concerned. Therefore, the standard of care is represented by breast-conserving surgery, with or without radiotherapy, as in younger patients. Mastectomy is only recommended for large or multifocal tumors. Oncoplastic and reconstructive breast surgical techniques are considered safe even for elderly women.

Hormone therapy alone should be reserved only for patients with severe comorbidities, the “frail” for surgery, or for those who refuse surgery.


Elderly Breast neoplasms Decision-making Breast neoplasms/surgery Geriatric assessment Breast neoplasms/therapy 



We thank Nicholas J. Collerton for his collaboration and translation.


  1. 1.
    Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, Reed M, Ciatto S, Voogd AC, Brain E, Cutuli B, Terret C, Gosney M, Aapro M, Audisio R. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol. 2012;13(4):e148–60.CrossRefGoogle Scholar
  2. 2.
    Yancik R. Cancer burden in the aged. An epidemiologic and demographic overview. Cancer. 1997;80(7):1273–83.CrossRefGoogle Scholar
  3. 3.
    Galante E, Cerrotta A, Martelli G, Del Prato I, Moglia D, Piromalli D. Treatment of breast cancer in elderly women: retrospective analysis of 111 wide lumpectomies performed in a day hospital regimen between 1982 and 1988. Tumori. 1992;78(2):111–4.CrossRefGoogle Scholar
  4. 4.
    Martelli G, DePalo G, Rossi N, Coradini D, Boracchi P, Galante E, Vetrella G. Long-term follow-up of elderly patients with operable breast cancer treated with surgery without axillary dissection plus adjuvant tamoxifen. Br J Cancer. 1995;72(5):1251–5.CrossRefGoogle Scholar
  5. 5.
    Distante V, Ciatto S, Frigerio A, Naldoni C, Paci E, Ponti A, del Turco MR, Vettorazzi M, Zappa M. Recommendations of a national Italian consensus conference on the opportunity of extending screening service by mammography to 40-49 and 70-74 years of age women. Epidemiol Prev. 2007;31(1):15–22.PubMedGoogle Scholar
  6. 6.
    Wildiers H, Kunkler I, Biganzoli L, et al. Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol. 2007;8:1101–15.CrossRefGoogle Scholar
  7. 7.
  8. 8.
    National Cancer Institute (NCI). Surveillance, Epidemiology, and End Results (SEER) program. URL: Accessed 30 Oct 2014.
  9. 9.
    AIRTUM. I numeri del cancro in Italia 2016. Accessed 10 Jan 2017.
  10. 10.
    Shachar SS, Hurria A, Muss HB. Breast cancer in women older than 80 years. J Oncol Pract. 2016;12(2):123–32.CrossRefGoogle Scholar
  11. 11.
    Schairer C, Mink PJ, Carroll L, et al. Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst. 2004;96:1311–21.CrossRefGoogle Scholar
  12. 12.
    Vicini E, Swaminathan V, Audisio RA. Management of breast cancer in elderly patients. Clin Pract. 2014;11(1):59–69.CrossRefGoogle Scholar
  13. 13.
    Honma N, Sakamoto G, Akiyama F, Esaki Y, Sawabe M, Arai T, Hosoi T, Harada N, Younes M, Takubo K. Breast carcinoma in women over the age of 85: distinct histological pattern and androgen, oestrogen, and progesterone receptor status. Histopathology. 2003;42(2):120–7.CrossRefGoogle Scholar
  14. 14.
    Tesarova P. Specific aspects of breast cancer therapy of elderly women. Biomed Res Int. 2016;2016:1381695.CrossRefGoogle Scholar
  15. 15.
    Syed BM, Green AR, Paish EC, Soria D, Garibaldi J, Morgan L, Morgan DA, Ellis IO, Cheung KL. Biology of primary breast cancer in older women treated by surgery: with correlation with long-term clinical outcome and comparison with their younger counterparts. Br J Cancer. 2013;108(5):1042–51.CrossRefGoogle Scholar
  16. 16.
    Bergen ES, Tichy C, Berghoff AS, Rudas M, Dubsky P, Bago-Horvath Z, Mader RM, Exner R, Gnant M, Zielinski CC, Steger GG, Preusser M, Bartsch R. Prognostic impact of breast cancer subtypes in elderly patients. Breast Cancer Res Treat. 2016;157(1):91–9.CrossRefGoogle Scholar
  17. 17.
    Molino A, Giovannini M, Auriemma A, Fiorio E, Mercanti A, Mandarà M, et al. Pathological, biological and clinical characteristics, and surgical management, of elderly women with breast cancer. Crit Rev Oncol Hematol. 2006;59:226–33.CrossRefGoogle Scholar
  18. 18.
    DeSantis C, Siegel R, Bandi P, Jemal A. Breast cancer statistics, 2011. CA Cancer J Clin. 2011;61(6):409–18.CrossRefGoogle Scholar
  19. 19.
    Schonberg MA, Li VW, Eliassen AH, Davis RB, LaCroix AZ, McCarthy EP, Rosner BA, Chlebowski RT, Rohan TE, Hankinson SE, Marcantonio ER, Ngo LH. Performance of the breast cancer risk assessment tool among women age 75 years and older. J Natl Cancer Inst. 2015;108(3):djv348.CrossRefGoogle Scholar
  20. 20.
    Cortadellas T, Córdoba O, Gascón A, Haladjian C, Bernabeu A, Alcalde A, Esgueva A, Rodriguez-Revuelto R, Espinosa-Bravo M, Díaz-Botero S, Xercavins J, Rubio IT, Gil-Moreno A. Surgery improves survival in elderly with breast cancer. A study of 465 patients in a single institution. Eur J Surg Oncol. 2015;41(5):635–40.CrossRefGoogle Scholar
  21. 21.
    Ecomard LM, Malingret N, Asad-Syed M, Dilhuydy MH, Madranges N, Payet C, Debled M. Breast cancer diagnosis among women aged 75 and over: study on information delivered by organized breast cancer screening agencies to women reaching the limit age. Bull Cancer. 2013;100(7–8):671–6.PubMedGoogle Scholar
  22. 22.
    Barratt AL, Les Irwig M, Glasziou PP, et al. Benefits, harms and costs of screening mammography in women 70 years and over: a systematic review. Med J Aust. 2002;176:266–71.PubMedGoogle Scholar
  23. 23.
    Walter LC, Covinski KE. Cancer screening in elderly patients: a framework for individualized decision-making. JAMA. 2001;285:2750–6.CrossRefGoogle Scholar
  24. 24.
    Kesson EM, Allardice GM, George WD, Burns HJG, Morrison DS. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. Br Med J. 2012;344:1e9.CrossRefGoogle Scholar
  25. 25.
    Crucitti A, Puzziello A, Amato B, editors. American College of Surgeons Gestione Peri-Operatoria Ottimale del Paziente Chirurgico Geriatrico: Rossi Srl; 2016. isbn:978-88-904063-1-7.Google Scholar
  26. 26.
    Rodin MB, Mohile SG. A practical approach to geriatric assessment in oncology. J Clin Oncol. 2007;25:1938–44.CrossRefGoogle Scholar
  27. 27.
    Pallis AG, Fortpied C, Wedding U, et al. EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer. 2010;46:1502–13.CrossRefGoogle Scholar
  28. 28.
    Williamson J, Stokoe IH, Gray S, Fisher M, Smith A, McGhee A, et al. Old people at home. Their unreported needs. Lancet. 1964;1(7343):1117–20.CrossRefGoogle Scholar
  29. 29.
    Hamerman D. Toward an understanding of frailty. Ann Intern Med. 1999;130(11):945–50.CrossRefGoogle Scholar
  30. 30.
    Parks RM, Lakshmanan R, Winterbottom L, Al Morgan D, Cox K, Cheung KL. Comprehensive geriatric assessment for older women with early breast cancer – a systematic review of literature. World J Surg Oncol. 2012;10:88.CrossRefGoogle Scholar
  31. 31.
    Audisio RA. Tailoring surgery to elderly patients with cancer. Br J Surg. 2016;103(2):e10–1.CrossRefGoogle Scholar
  32. 32.
    Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L, Fisher E, Deutsch M, Caplan R, Pilch Y, et al. Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1989;320(13):822–8.CrossRefGoogle Scholar
  33. 33.
    Goldenberg IS, Janus ZL, Bailar JC 3rd, Eisenberg H. Survival patterns of elderly women with breast cancer. Arch Surg. 1969;99(5):649–51.CrossRefGoogle Scholar
  34. 34.
    Curigliano G, Cardoso F, Costa A, Galimberti V, Goldhirsch A, Pelicci PG, Veronesi P, Viale G, Orecchia R. From the maximum tolerable to the minimum effective treatment: the Umberto Veronesi's life commitment to breast cancer care. Breast. 2017;31:241–3.CrossRefGoogle Scholar
  35. 35.
    James R, McCulley SJ, Macmillan RD. Oncoplastic and reconstructive breast surgery in the elderly. Br J Surg. 2015;102(5):480–8.CrossRefGoogle Scholar
  36. 36.
    Kaur P, Santillan AA, McGuire K, Turaga KK, Shamehdi C, Meade T, et al. The surgical treatment of breast cancer in the elderly: a single institution comparative review of 5235 patients with 1028 patients ≥70 years. Breast J. 2012;18(5):428–35.CrossRefGoogle Scholar
  37. 37.
    Advanced breast cancer – an integrated view everything NICE as said. Accessed 10 Jan 2017.
  38. 38.
    Lipa JE, Youssef AA, Kuerer HM, Robb GL, Chang DW. Breast reconstruction in older women: advantages of autogenous tissue. Plast Reconstr Surg. 2003;111(3):1110–21.CrossRefGoogle Scholar
  39. 39.
    Selber JC, Bergey M, Sonnad SS, Kovach S, Wu L, Serletti JM. Free flap breast reconstruction in advanced age: is it safe? Plast Reconstr Surg. 2009;124(4):1015–22.CrossRefGoogle Scholar
  40. 40.
    Martelli G, Miceli R, Daidone MG, et al. Axillary dissection versus no axillary dissection in elderly patients with breast cancer and no palpable axillary nodes: results after 15 years of follow-up. Ann Surg Oncol. 2011;18:125–33.CrossRefGoogle Scholar
  41. 41.
    Bromham N, Schmidt-Hansen M, Astin M, Hasler E, Reed MW. Axillary treatment for operable primary breast cancer. Cochrane Database Syst Rev. 2017;1:CD004561. Scholar
  42. 42.
    Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013;31:2382–7.CrossRefGoogle Scholar
  43. 43.
    Veronesi U, Luini A, del Vecchio M, Greco M, Galimberti V, Merson M, et al. Radiotherapy after breast-preserving surgery in women with localised cancer of the breast. N Engl J Med. 1993;328:1587–91.CrossRefGoogle Scholar
  44. 44.
    Kunkler I. Avoiding radiotherapy is an option for some older patients with breast cancer. In: San Antonio Breast Cancer Symposium 2013, San Antonio, 2013.Google Scholar
  45. 45.
    Blamey RW, Bates T, Chetty U, Duffy SW, Ellis IO, George D, et al. Radiotherapy or tamoxifen after conserving surgery for breast cancers of excellent prognosis: British Association of Surgical Oncology (BASO) II trial. Eur J Cancer. 2013;49:2294–302.CrossRefGoogle Scholar
  46. 46.
    Mustacchi G, Ceccherini R, Milani S, et al. Tamoxifene alone vs adjuvant tamoxifen for operable breast cancer of the elderly: long-term results of the phase III randomized controlled multicenter GRETA trial. Ann Oncol. 2003;14:414–20.CrossRefGoogle Scholar
  47. 47.
    Gazet JC, Ford H, Coombes RC. Prospective randomised trial of tamoxifen versus surgery in elderly patients with breast cancer. Eur J Surg Oncol. 1994;20:207–14.PubMedGoogle Scholar
  48. 48.
    Hind D, Wyld L, Beverley CB, Reed MW. Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus). Cochrane Database Syst Rev. 2006;1:CD004272.Google Scholar
  49. 49.
    Morgan JL, Richards P, Zaman O, Ward S, Collins K, Robinson T, Cheung KL, Audisio RA, Reed MW, Wyld L, Bridging the Age Gap in Breast Cancer Trial Management Team. The decision-making process for senior cancer patients: treatment allocation of older women with operable breast cancer in the UK. Cancer Biol Med. 2015;12(4):308–15.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Marsilio Francucci
    • 1
  • Roberto Cirocchi
    • 2
  • Marina Vinciguerra
    • 1
  1. 1.General Surgery and Day Surgery UnitHospital of TerniTerniItaly
  2. 2.General Surgical and Surgical Oncology UnitUniversity of PerugiaPerugiaItaly

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