Skip to main content

Advertisement

Log in

Breast cancer in elderly women. Optimizing the treatment

  • Review
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

The elderly population is on the rise. Breast cancer is the most common cancer in western women and its incidence increases with age. Despite the epidemiological burden of this condition, there is a lack of knowledge regarding the management of older patients, as treatment planning is mainly based on personal preferences rather than hard data. Older women are often offered sub-optimal treatment when compared to their younger counterpart at any particular stage. This is due to various reasons, including the lack of scientific evidence from well-conducted clinical trials. Reluctance to prescribe systemic treatments may be explained by the complexity of cost-benefit evaluations in such patients. It is also an ethical dilemma to decide how aggressive one should be when it comes to treat cancer in the elderly in view of the higher rate of cognitive impairment and specific patients’ expectations. This paper reviews the currently available evidence and attempts presenting and discussing chemoprevention of breast cancer, risk and benefit of hormone replacement therapy and the various treatment options for older women with breast cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Kimmick GG, Balducci L (2000) Breast cancer and aging: clinical interactions. Hematol Oncol Clin North Am 14:213–234

    Article  PubMed  CAS  Google Scholar 

  2. Ries LAG, Kosary CL, Hankey BF et al (1998) National cancer institute seer cancer statistics review 1973-1995 (specific data from NCHS Public Use Tape). National Cancer Institute, Bethesda, MD

    Google Scholar 

  3. Lash TL, Silliman RA (1998) Prevalence of cancer. J Natl Cancer Inst 90:399–400

    Article  PubMed  CAS  Google Scholar 

  4. Parkin DM, Bray FI, Devesa SS (2001) Cancer burden in the year 2000. The global picture. Eur J Cancer 37:S4–S66

    Article  PubMed  Google Scholar 

  5. Guralnik JM (1996) Assessing the impact of comorbidity in the older population. Ann Epidemiol 6:376–380

    Article  PubMed  CAS  Google Scholar 

  6. Mandelblatt JS, Bierman AS, Gold K et al (2001) Constructs of burden of illness in older patients with breast cancer: comparison of measurement methods. Health Serv Res 36:1085–107

    PubMed  CAS  Google Scholar 

  7. National Institutes of Health (1991) NIH Consensus Conference: treatment of early breast cancer. JAMA 265:391–395

    Article  Google Scholar 

  8. Nattinger AB, Gottlieb MS, Veum J et al (1992) Geographic variation in the use of breast-conserving treatment for breast cancer. N Engl J Med 326:1147–1149

    Article  Google Scholar 

  9. Cancer and Leukemia Group B (1999) Protocol no. 9343: Tamoxifen vs. radiotherapy and tamoxifen after breast conservation in the elderly with local disease. Cancer and Leukemia Group B, Chicago, IL

  10. Hughes K, Schnaper L, Berry D et al (2004) Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 351:971–977

    Article  PubMed  CAS  Google Scholar 

  11. Turner RR, Ollila DW, Krasne DL et al (1997) Histopathologic validation of the sentinel lymph node hypothesis for breast carcinoma. Ann Surg 226:271–276

    Article  PubMed  CAS  Google Scholar 

  12. Goldhirsch A, Glick JH, Gelber RD et al (2005). Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol 16:1569–1583

    Article  PubMed  CAS  Google Scholar 

  13. Ashing-Giwa K, Ganz PA, Petersen L (1999) Quality of life of African-American and white long term breast carcinoma survivors. Cancer 85:418–426

    Article  PubMed  CAS  Google Scholar 

  14. Eaker S, Dickman PW, Bergkvist L et al (2006) Differences in management in older women influence breast cancer survival: results from a population-based database in Sweden. PLoS 3:e25

    Article  Google Scholar 

  15. Bouchardy C, Rapiti E, Fioretta G et al (2003) Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol 21:3580–3587

    Article  PubMed  Google Scholar 

  16. Audisio RA, Bozzetti F, Gennari R et al (2004) The surgical management of senior cancer patients: opinions of the SIOG surgical task force. Eur J Cancer 40:926–938

    Article  PubMed  CAS  Google Scholar 

  17. Spencer G (1989) Projections of the population of the United States by age, sex and race 1988–2080. Washington DC. US Government Printing Office; Current Population Reports: series p 25 No.1018

  18. Sclare G (1991) Malignancy in nonagenarians. Scott Med J 36:12–15

    PubMed  CAS  Google Scholar 

  19. Stampfer MJ, Colditz GA (1991) Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiological evidence. Prev Med 20:47–63

    Article  PubMed  CAS  Google Scholar 

  20. Kiel DP, Felson DT, Andersen JJ et al (1987) Hip fracture and the use of estrogens in postmenopausal women. The framingham study. N Engl J Med 317:1169–1174

    Article  PubMed  CAS  Google Scholar 

  21. Tang M, Jacobs D, Stern Y et al (1996) Effect of oestrogen during menopause on risk and age at onset of Alzzheimer’s disease. Lancet 34:429–4328

    Article  Google Scholar 

  22. Theriault RL (1996) Hormone replacement therapy and breast cancer: an overview. Br J Ob Gyn 103(13S):87–91

    Google Scholar 

  23. Farquhar CM, Marjoribanks J, Lethaby A et al (2005) Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 20(3):CD004143

    Google Scholar 

  24. Rossouw JE, Anderson GL, Prentice RL et al (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333

    Article  PubMed  CAS  Google Scholar 

  25. Ravdin PM, Cronin KA, Howlader N et al (2007) The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 356:1670–1674

    Article  PubMed  CAS  Google Scholar 

  26. Fisher B, Costantino JP, Wickerham DL et al (1998) Tamoxifen for prevention of breast cancer: report of the national surgical adjuvant breast and bowel project p-1 study. J Natl Cancer Inst 90:1371–1388

    Article  PubMed  CAS  Google Scholar 

  27. Fisher B, Costantino JP, Wickerham DL et al ( 2005) Tamoxifen for the prevention of breast cancer: current status of the national surgical adjuvant breast and bowel project p-1 study. J Natl Cancer Inst 97:1652–1662

    PubMed  CAS  Google Scholar 

  28. Cuzick J, Forbes JF, Sestak I et al (2007) Long-term results of tamoxifen prophylaxis for breast cancer–96-month follow-up of the randomized IBIS-I trial. J Natl Cancer Inst 99:272–282

    Article  PubMed  CAS  Google Scholar 

  29. Vogel VG, Costantino JP, Wickerham DL et al (2006) Effects of tamoxifen vs raloxifen on the risk of developing breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 295:2727–2741

    Article  PubMed  CAS  Google Scholar 

  30. Dunn BK, Wickerham DL, Ford LG (2005) Prevention of hormone-related cancers: breast cancer. J Clin Oncol 23:4469–4470

    Article  Google Scholar 

  31. Sweeney C, Blair CK, Anderson KE et al. (2004) Risk factors for breast cancer in elderly women. Amer J Epidemiol 160:868–875

    Article  Google Scholar 

  32. Diab SG, Elledge RM, Clark GM (2000) Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst 92:550–556

    Article  PubMed  CAS  Google Scholar 

  33. Gennari R, Curigliano G, Rotmensz N et al (2004) Breast carcinoma in elderly women. Features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients. Cancer 101:302–310

    Article  Google Scholar 

  34. Freyer G, Braud AC, Chaibi P et al (2006) Dealing with metastatic breast cancer in elderly women: results from a French study on a large cohort carried out bi the “Observatory on elderly patients”. Ann Oncol 17:211–216

    Article  PubMed  CAS  Google Scholar 

  35. Grann VR, Troxel AB, Zojwalla NJ et al (2005) Hormone receptor status and survival in a population-based cohort of patients with breast carcinomas. Cancer 103:2241–2251

    Article  PubMed  CAS  Google Scholar 

  36. Pierga JY, Girre V, Laurence V et al (2004) Characteristics and outcome of 1755 operable breast cancers in women over 70 years of age. Breast 13:369–375

    Article  PubMed  Google Scholar 

  37. Nixon AJ, Neuberg D, Hayes DF et al (1994) Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 12:888–894

    PubMed  CAS  Google Scholar 

  38. Molino A, Giovannini M, Auriemma A et al (2006) Pathological, biological and clinical characteristics, and surgical management of elderly women with breast cancer. Crit Rev Oncol Hematol 59:226–233

    Article  PubMed  Google Scholar 

  39. Daidone MG, Coradini D, Martelli G et al (2003) Primary breast cancer in elderly women: biological profile and relation with clinical outcome. Crit Rev Oncol Hematol 45:313–325

    Article  PubMed  Google Scholar 

  40. van Dijck JA, Holland R, Verbeek AL et al (1994) Efficacy of mammographic screening in the elderly: a case-referent study in the Nijmegen program in the Netherlands. J Natl Cancer Inst 86:934–938

    Article  PubMed  Google Scholar 

  41. McCarthy EP, Burns RB, Freund KM et al (2000) Mammography use, breast cancer stage at diagnosis, ad survival among older women. J Am Ger Soc 48:1226–1233

    CAS  Google Scholar 

  42. Randolph WM, Goodwin JS, Mahnken JD et al (2002) Regular mammography use is associated with elimination of age-related disparities in size and stage of breast cancer diagnosis. Ann Int Med 137:783–790

    PubMed  Google Scholar 

  43. McPherson CP, Swenson KK, Lee MW (2002) The effects of mammographic detection and co-morbidity on the survival of older women with breast cancer. J Am Ger Soc 50:1061–1068

    Article  Google Scholar 

  44. Pestalozzi BC, Luporsi-Gely E, Jost LM et al (2005) ESMO Minimum Clinical Recommendations for diagnosis, adjuvant treatment and follow-up of primary breast cancer. Ann Oncol 16(Suppl 1):i7–i9

    Article  PubMed  Google Scholar 

  45. Preece PE, Wood RA, Mackie CR (1982). Tamoxifen as initial sole treatment of localised breast cancer in elderly women: a pilot study. Br Med J 284:869–870

    Article  CAS  Google Scholar 

  46. Audisio RA, Ramesh H, Longo WE et al (2005) Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist 10:262–268

    Article  PubMed  Google Scholar 

  47. Pope D, Ramesh H, Gennari R et al (2007) Preoperative Assessment of Cancer in the Elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol 15:189–197

    Article  Google Scholar 

  48. Bland KI, Scott-Conner BE, Menck H et al (1999) Axillary dissection in breast conserving surgery for stage I and stage II breast cancer: a National Cancer Data Base Study of patterns of omission and implications for survival. J Amer Coll Surgeons 188:586–595

    Article  CAS  Google Scholar 

  49. Kuehn T, Klauss W, Darsow M et al (2000) Long term morbidity following axillary surgery dissection in breast cancer patients—clinical assessment, significance for life quality and impact of demographic, oncologic and therapeutic factors. Breast Cancer Res Treat 64:275–282

    Article  PubMed  CAS  Google Scholar 

  50. Chetty U, Jack W, Prescott RJ et al (2002) Management of the axilla in operable breast cancer treated by breast conserving surgery: a randomized trial. Edinburgh Breast Unit. Br J Surg 87:163–169

    Article  Google Scholar 

  51. Hind D, Wyld L, Beverley CB et al (2006) Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus) (Review). Cochrane Database Syst Rev (1):CD004272

  52. Martelli G, Boracchi P, De Palo M et al (2005) A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: results after 5 years of follow-up. Ann Surg 242:1–6

    Article  PubMed  Google Scholar 

  53. Rudenstam CM, Zahrieh D, Forbes JF et al (2006) International Breast Cancer Study Group. Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10–93. J Clin Oncol 24:337–344

    Article  PubMed  Google Scholar 

  54. Veronesi U, Paganelli G, Viale G et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546–553

    Article  PubMed  Google Scholar 

  55. Gennari R, Rotmensz N, Perego E et al (2004) Sentinel node biopsy in elderly breast cancer patients. Surg Oncol 13:193–196

    Article  PubMed  Google Scholar 

  56. Bowman CC, Lennox PA, Clugston PA et al (2006) Breast reconstruction in older women: should age be an exclusion criterion? Plast Reconstr Surg 118:16–22

    Article  PubMed  CAS  Google Scholar 

  57. Lipa JE, Youssef AA, Kuerer HM et al (2003) Breast reconstruction in older women: advantages of autogenous tissue. Plast Reconst Surg 111:1110–1121

    Article  PubMed  Google Scholar 

  58. Truong PT, Bernstein V, Lesperance M et al (2006) Radiotherapy omission after breast-conserving surgery is associated with reduced breast cancer-specific survival in elderly women with breast cancer. Am J Surg 191:749–755

    Article  PubMed  Google Scholar 

  59. Smith BD, Gross CP, Smith GL (2006) Effectiveness of radiation therapy for older women with early breast cancer. J Natl Cancer Inst 98:681–690

    Article  PubMed  Google Scholar 

  60. Manders K, van de Poll-Franse LV, Creemers GJ et al (2006) Clinical management of women with metastatic breast cancer: a descriptive study according to age group. BMC Cancer 6:179

    Article  PubMed  Google Scholar 

  61. Hershman DL, Wang X, McBride R et al (2006) Delay in initiating adjuvant radiotherapy following breast conservation surgery and its impact on survival to elderly patients. Int J Radiat Oncol Biol Phys 65:1353–1360

    PubMed  Google Scholar 

  62. www.prime2.org

  63. Geiger AM, Thwin SS, Lash TL et al (2007) Recurrences and second primary breast cancers in older women with initial early-stage disease. Cancer 109:966–974

    Article  PubMed  Google Scholar 

  64. Smith BD, Haffty BG, Hurria A et al (2006). Postmastectomy radiation and survival older women with breast cancer. J Clin Oncol 24:4901–4907

    Article  PubMed  Google Scholar 

  65. DiFronzo LA, Tsai PI, Hwang JM et al (2005) Breast conserving surgery and accelerated partial breast irradiation using the MammoSite system: initial clinical experience. Arch Surg 140:787–794

    Article  PubMed  Google Scholar 

  66. Gennari R, Perego E, Ballardini B et al (2004) Surgical technique of Mammosite RTS implant for accelerated radiation delivery in breast conservative treatment. J Exp Clin Cancer Res 23:411–415

    PubMed  CAS  Google Scholar 

  67. Veronesi U, Orecchia R, Luini A et al (2005) Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases. Ann Surg 242:101–106

    Article  PubMed  Google Scholar 

  68. Orecchia R, Veronesi U (2005) Intraoperative electrons. Semin Radiat Oncol 15:76–83

    Article  PubMed  Google Scholar 

  69. Eifel P, Axelson JA, Costa J et al (2001) National Institute of Health Consensus Development Statement: adjuvant therapy for breast cancer, November 1–3, 2000. J Natl Cancer Inst 93:979–989

    Article  PubMed  CAS  Google Scholar 

  70. Early Breast Cancer Trialists’ Collaborative Group (2005) Effect of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of randomised trials. Lancet 365:1687–1717

    Article  CAS  Google Scholar 

  71. Crivellari D, Price K, Gelber RD et al (2003) Adjuvant endocrine therapy compared with no systemic therapy for elderly women with early breast cancer. 21-Year results of International Breast Cancer Study Group Trial IV. J Clin Oncol 21:4517–4523

    Article  PubMed  CAS  Google Scholar 

  72. Thurlimann B, Keshaviah A, Coates AS et al (2005) A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med 353:2747–2757

    Article  PubMed  Google Scholar 

  73. ATAC Trialists Group (2006) Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 365:60–62

    Google Scholar 

  74. The ATAC (Arimidex, Tamoxifen Alone or in Combination) Trialists’ group (2002) Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet 359:2131–2139

    Article  Google Scholar 

  75. The Breast International Group BIG 1–98 (2005) Randomized double blind phase III study to evaluate letrozole (L) vs tamoxifen (T) as adjuvant endocrine therapy for postmenopausal women with receptor positive breast cancer. N Engl J Med 353:2747–2757

    Article  Google Scholar 

  76. A Muss (2001) Older age: not a barrier to cancer treatment. N Engl J Med 345:1128–1129

    Article  Google Scholar 

  77. Mitka M (2003) Too few older patients in cancer trials. JAMA 290:27–28

    Article  PubMed  Google Scholar 

  78. Holmes CE, Muss HB (2003) Diagnosis and treatment of breast cancer in the elderly. CA Cancer J Clin 53:227–244

    Article  PubMed  Google Scholar 

  79. Lewis JH, Kilgore ML, Goldman DP et al (2003) Partecipation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol 21:1383–1389

    Article  PubMed  Google Scholar 

  80. Hutchins LF, Unger JM, Crowley JJ et al (1999) Underrepresentation of 65 years of age or older in cancer-treatment trials. N Engl J Med 30:2061–2067

    Article  Google Scholar 

  81. Elkin EB, Hurria A, Mitra N et al (2006) Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: assessing outcome in a population-based, observational cohort. J Clin Oncol 24:2757–2764

    Article  PubMed  Google Scholar 

  82. Giordano SH, Duan Z, Kuo YF et al (2006) Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol 24:2750–2756

    Article  PubMed  Google Scholar 

  83. Berry DA, Cirrincione C, Henderson IC et al (2006) Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA 295:1658–1667

    Article  PubMed  CAS  Google Scholar 

  84. Muss HB, Woolf S, Berry D et al (2005) Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA 293:1073–1081

    Article  PubMed  CAS  Google Scholar 

  85. Early Breast Cancer Trialists’ Collaborative Group (1998) Polychemotherapy for early breast cancer: an overview of randomised trial. Lancet 352:930–942

    Article  Google Scholar 

  86. Crivellari D, Bonetti M, Castiglione Geertsch M et al (2000) Burdens and benefit of adjuvant cyclophosphamide, methotrexate, and fluorouracil and tamoxifen for elderly patients with breast cancer: the International Breast Cancer Study Group Trial VII. J Clin Oncol 18:1412–1422

    PubMed  CAS  Google Scholar 

  87. Gelman RS, Taylor SG 4th (1984) Cyclophosphamide, methotrexate and 5-fluorouracil chemiotherapy in women more than 65 years old with advanced breast cancer: the elimination of age trands in toxicity by using doses based on creatinine clearance. J Clin Oncol 2:1404–1413

    Google Scholar 

  88. Wils JA, Bliss JM, Marty M et al (1999) Epirubicin plus tamoxifen versus tamoxifen alone in node positive postmenopausal patients with breast cancer: a randomized trial of the international collaborative cancer group. J Clin Oncol 17:1988–1999

    PubMed  CAS  Google Scholar 

  89. Ibrahim NK, Frye DK, Buzdar AU (1996) Doxorubicin-based chemotherapy in elderly patients with metastatic breast cancer. Tolerance and outcome. Arch Intern Med 156:882–888

    Article  PubMed  CAS  Google Scholar 

  90. Constenla M, Lorenzo I, Carrete N et al (2000) Docetaxel (TXT) monotherapy & G-CSF for advanced breast cancer (ABC) in elderly patients (EP). Proc Am Soc Clin Oncol 19:425

    Google Scholar 

  91. Smith I, Procter M, Gelber RD et al (2007) 2-Year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: a randomised controlled trial. Lancet 369:29–36

    Article  PubMed  CAS  Google Scholar 

  92. Romond EH, Perez EA, Bryant et al (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. New Engl J Med 353:1673–1684

  93. http://www.adjuvantonline.com

  94. Burdette-Radoux S, Muss HB (2006) Adjuvant chemotherapy in the elderly: whom to treat, what regimen? Oncologist 11:234–242

    Article  PubMed  Google Scholar 

  95. Ramia JM, Villar J, Villegas T et al (2005) Surgical treatment of liver metastases from breast cancer. Cir Esp 78:318–322

    Article  PubMed  Google Scholar 

  96. d’Annibale M, Piovanello P, Cerasoli V et al (2005) Liver metastases from breast cancer: the role of surgical treatment. Hepatogastroenterology 52:1858–1862

    PubMed  CAS  Google Scholar 

  97. Rapiti E, Verkooijen HM, Vlastos G et al (2006) Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol 24:2743–2749

    Article  PubMed  Google Scholar 

  98. Ellis MJ, Coop A, Singh B et al (2001) Letrozole is more effective neoadjuvant endocrine therapy than tamoxifen for ErbB-1- and/or ErbB-2-positive, estrogen receptor-positive primary breast cancer: evidence from a phase III randomized trial. J Clin Oncol 19:3808–3816

    PubMed  CAS  Google Scholar 

  99. Joensuu H, Ejlertaen B, Lonning PE (2005) Aromatase inhibitors in the treatment of early and advanced breast cancer. Acta Oncol 44:23–31

    Article  PubMed  CAS  Google Scholar 

  100. Howell A, Robertson JFR, Quaresma AJ et al (2002) Fulvestran, formerly ICI 182780, is as effective as anastrozole in postmenopausal women with advanced breast cancer progressing after prior endocrine treatment. J Clin Oncol 20:2296–3403

    Article  CAS  Google Scholar 

  101. Botteman M, Barghout V, Stephens J et al (2006) Cost effectiveness of biphosphonates in the management of breast cancer patients with bone metastases. Ann Oncol 17:1072–1082

    Article  PubMed  CAS  Google Scholar 

  102. Miles D, Von Minckwitz G, Seiderman A (2002) Combination versus sequential single-agent therapy in metastatic breast cancer. Oncologist 7:13–19

    PubMed  CAS  Google Scholar 

  103. Jones SE, Erban J, Overmoyer B et al (2005) Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer. J Clin Oncol 23:5542–5551

    Article  PubMed  CAS  Google Scholar 

  104. Del Mastro L, Perrone F, Repetto L et al (2005) Weekly paclitaxel as first-line chemotherapy in elderly advanced breast cancer patients: a phase II study of the Gruppo Italiano di Oncologia Geriatrica (GIOGer). Ann Oncol 16:253–258

    Article  PubMed  Google Scholar 

  105. Feher O, Vodvarka P, Jessem J et al (2005) First-line gemcitabine versus epirubicin in postmenopausal women aged 60 or older with metastatic breast cancer: a multicentric, randomised, phase III study. Ann Oncol 16:899–908

    Article  PubMed  CAS  Google Scholar 

  106. Bajetta E, Procopio G, Celio L et al (2005) Safety and efficacy of two different doses of capecitabine in the treatment of advanced breast cancer in older women. J Clin Oncol 23:1–7

    Article  CAS  Google Scholar 

  107. Crivellari D, Lombardi D, Corona G et al (2006) Innovative schedule of oral idarubicin in elderly patients with metastatic breast cancer: comprehensive results of phase II multi-istitutional study with pharmacokinetic drug monitoring. Ann Oncol 17:807–812

    Article  PubMed  CAS  Google Scholar 

  108. Hess D, Thurlimann B, Pagani O et al (2004) Capecitabine and vinorelbine in edeely patients (>or=65 years) with metastatic breast cancer. A phase I trial (SAKK 25/99). Ann Oncol 15:1760–1765

    Article  PubMed  CAS  Google Scholar 

  109. Crivellari D, Price K, Gelber RD et al (2003) Adjuvant endocrine therapy compared with no systemic therapy for elderly women with early breast cancer: 21-year results of International Breast Cancer Study Group Trial IV. J Clin Oncol 21:4517–4523

    Article  PubMed  CAS  Google Scholar 

  110. Fisher CJ, Egan MK, Smith P et al (1997) Histopathology of breast cancer in relation to age. Br J Cancer 75:593–596

    PubMed  CAS  Google Scholar 

  111. Coates AS (1999) Breast cancer: delays, dilemmas, and delusions. Lancet 353:1112–1113

    Article  PubMed  CAS  Google Scholar 

  112. Bergman L, Kluck HM, van Leeuwen FE et al (1992) The influence of age o treatment choice and survival of elderly breast cancer patients in south-eastern Netherlands: a population-based study. Eur J Cancer 28A:1475–1480

    Article  PubMed  CAS  Google Scholar 

  113. de Rijke JM, Schouten LJ, Schouten HC et al (1996) Age-specific differences in the diagnostics and treatment of cancer aged 50 years and older in the province of Limburg, The Netherlands. Ann Oncol 7:677–685

    PubMed  Google Scholar 

  114. Yancik R, Ries LA (2000). Aging and cancer in America: demographic and epidemiologic perspectives. Hematol Oncol Clin North Am 14:17–23

    Article  PubMed  CAS  Google Scholar 

  115. Biganzoli L, Aapro M, Balducci L et al (2004) Adjuvant therapy in elderly patients with breast cancer. Clin Breast Cancer 5:188–195

    Article  PubMed  CAS  Google Scholar 

  116. Coebergh JWW (1996) Significant trends in cancer in the elderly. Eur J Cancer 32A:569–571

    Article  PubMed  CAS  Google Scholar 

  117. Lipschitz DA, Goldstein S, Weksler ME et al (1985) Cancer in the elderly: basic science and clinical aspects. Ann Intern Med 102:218–228

    PubMed  CAS  Google Scholar 

  118. Balducci L, Beghe C (2001). Cancer and age in USA. Crit Rev Oncol Hematol 37:137–145

    Article  PubMed  CAS  Google Scholar 

  119. Rao VS, Garimella V, Hwang M et al (2007) Management of early breast cancer in the elderly. Int J Can 120:1155–1160

    Article  CAS  Google Scholar 

  120. Passage KJ, McCarthy NJ (2007) Critical review of the management of early-stage breast cancer in elderly women. Intern Med J 37:181–189

    Article  PubMed  CAS  Google Scholar 

  121. Tejeda HA, Green SB, Trimble EL et al (1996) Representation of African-Americans, Hispanics, and withes in National Cancer Institute cancer treatment trials. J Natl Cancer Inst 88:812–816

    Article  PubMed  CAS  Google Scholar 

  122. Fentiman IS, Tirelli U, Monfardini S et al (1990) Cancer in the elderly: why so badly treated? Lancet 335:1020–1022

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgement

We wish to thank Dr. Claudia Cuzzoni for assembling the manuscript and Mr. Ron Norton for reviewing it.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Roberto Gennari.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gennari, R., Audisio, R.A. Breast cancer in elderly women. Optimizing the treatment. Breast Cancer Res Treat 110, 199–209 (2008). https://doi.org/10.1007/s10549-007-9723-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-007-9723-4

Keywords

Navigation