Skip to main content

Advertisement

SpringerLink
Log in

Management issues for elderly patients with breast cancer

  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Fifty percent of breast cancers occur after the age of 65 years and 25% occur after the age of 75 years. Encountering a breast cancer in an older woman is frequent. After years of dearth of data specific to the elderly, some evidence is beginning to accumulate concerning breast cancer in the older woman. Recent data from mammography studies confirm its effectives in women with 10 years or more of life expectancy (perhaps even 5 years). Epidemiologic and randomized studies demonstrate that a proper surgery and adjuvant treatment can decrease relapse and improve survival in patients older than 80 years. Radiation therapy studies show a decrease in local relapse even in patients older than 70 years. Adjuvant hormonal therapy has essentially the same effectiveness as in younger women. Chemotherapy has a role in patients older than 70 years. Consensus statements, such as the St. Gallen consensus, have dropped the age limit of 70 years from their recommendations. Comorbidity and life expectancy should be taken into account for proper selection of adjuvant treatment. The treatment of metastatic breast cancer has evolved significantly with the introduction of aromatase inhibitors, new chemotherapeutic agents, and targeted biologic agents. New chemotherapeutic agents are as effective as single agents compared to older and more toxic drug combinations. The cumulative result of the introduction of these new agents, at a population level, is a 7.5-month increase in the median survival time of patients with metastatic breast cancer over the past decade.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Trimble EL, Carter CL, Cain D, et al.: Representation of older patients in cancer treatment trials. Cancer 1994, 74:2208–2214.

    Article  PubMed  CAS  Google Scholar 

  2. Extermann M, Albrand G, Chen H, et al.: Are older French patients as willing as older American patients to undertake chemotherapy? J Clin Oncol 2003, 21:3214–3219. This article establishes that older patients with cancer on both sides of the Atlantic Ocean have an equal willingness to undertake treatment. Therefore, when interpreting literature from other countries, physicians should assume an equal willingness of the older patient to undertake treatment.

    Article  PubMed  Google Scholar 

  3. Gotzsche PC, Olsen O: Is screening for breast cancer with mammography justifiable? Lancet 2000, 355:129–134.

    Article  PubMed  CAS  Google Scholar 

  4. Nystrom L, Andersson I, Bjurstam N, et al.: Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet 2002, 359:909–919.

    Article  PubMed  Google Scholar 

  5. Miettinen OS, Henschke CI, Pasmantier MW, et al.: Mammographic screening: no reliable supporting evidence? Lancet 2002, 359:404–405.

    Article  PubMed  Google Scholar 

  6. McPherson CP, Swenson KW, Lee MW: The effects of mammographic detection and comorbidity on the survival of older women with breast cancer. J Am Geriatr Soc 2002, 50:1061–1068.

    Article  PubMed  Google Scholar 

  7. King MC, Wieand S, Hale K, et al.: Tamoxifen and breast cancer incidence among women with inherited mutations in BRCA1 and BRCA2: National Surgical Adjuvant Breast and Bowel Project (NSABP-P1) Breast Cancer Prevention Trial. JAMA 2001, 286:2251–2256.

    Article  PubMed  CAS  Google Scholar 

  8. Powles TJ: The Royal Marsden Hospital (RMH) trial: key points and remaining questions. Ann N Y Acad Sci 2001, 949:109–112.

    Article  PubMed  CAS  Google Scholar 

  9. Veronesi U, Maisonneuve P, Rotmensz N, et al.: Italian randomized trial among women with hysterectomy: tamoxifen and hormone-dependent breast cancer in high-risk women. J Natl Cancer Inst 2003, 95:160–165.

    Article  PubMed  CAS  Google Scholar 

  10. Cuzick J, Forbes J, Edwards R, et al.: First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial. Lancet 2002, 360:817–824.

    Article  PubMed  CAS  Google Scholar 

  11. Cauley JA, Norton L, Lippman ME, et al.: Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial. Multiple outcomes of raloxifene evaluation. Breast Cancer Res Treat 2001, 65:125–134. [Published erratum appears in Breast Cancer Res Treat 2001, 67:191.]

    Article  PubMed  CAS  Google Scholar 

  12. Veronesi U, Luini A, Del Vecchio M, et al.: Radiotherapy after breast-preserving surgery in women with localized cancer of the breast. N Engl J Med 1993, 328:1587–1591.

    Article  PubMed  CAS  Google Scholar 

  13. Mustacchi G, Latteier J, Milani S, et al.: Tamoxifen versus surgery plus tamoxifen as primary treatment for elderly patients with breast cancer: combined data from the “GRETA” and “CRC” trials [abstract]. Am Soc Clin Oncol 1998, 383.

  14. Bouchardy C, Rapiti E, Fioretta G, et al.: Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol 2003, 21:3580–3587. This population study focuses on women older than 80 years with breast cancer. It describes the real-life impact of breast cancer treatment.

    Article  PubMed  Google Scholar 

  15. Berger DH, Roslyn JJ: Cancer surgery in the elderly. Clin Geriatr Med 1997, 13:119–141.

    PubMed  CAS  Google Scholar 

  16. Irwig L, Bennetts A: Quality of life after breast conservation or mastectomy: a systematic review. Aust N Z J Surg 1997, 67:750–754.

    PubMed  CAS  Google Scholar 

  17. Nissen MJ, Swenson KK, Ritz LJ, et al.: Quality of life after breast carcinoma surgery: a comparison of three surgical procedures. Cancer 2001, 91:1238–1246.

    Article  PubMed  CAS  Google Scholar 

  18. Holmberg L, Lindgren A, Norden T, et al.: Age as a determinant of axillary node involvement in invasive breast cancer. Acta Oncol 1992, 31:533–538.

    PubMed  CAS  Google Scholar 

  19. Michaelson JS, Silverstein M, Sgroi D, et al.: The effect of tumor size and lymph node status on breast carcinoma lethality. Cancer 2003, 98:2133–2143.

    Article  PubMed  Google Scholar 

  20. Hughes KS, Schnaper L, Berry D, et al.: Comparison of lumpectomy plus tamoxifen with and without radiotherapy in women 70 years of age or older who have clinical stage I, estrogen receptor positive breast carcinoma [abstract]. Am Soc Clin Oncol 2001, 93. Accessible online at http://www.asco.org/ac/1,1003,_12-002511-00_18-0010-00_19-001230-00_21-001,00.asp.

  21. Wyckoff J, Greenberg H, Sanderson R, et al.: Breast irradiation in the older woman: a toxicity study. J Am Geriatr Soc 1994, 42:150–152.

    PubMed  CAS  Google Scholar 

  22. Buzdar A: The ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial in postmenopausal women with early breast cancer: updated efficacy results based on a median follow-up of 47 months [abstract]. San Antonio Breast Cancer Symp 2002, 13.

  23. Fisher B, Dignam J, Bryant J, Wolmark N: Five versus more than five years of tamoxifen for lymph nodenegative breast cancer: updated findings from the National Surgical Adjuvant Breast and Bowel Project B-14 randomized trial. J Natl Cancer Inst 2001, 93:684–690.

    Article  PubMed  CAS  Google Scholar 

  24. Stewart HJ, Prescott RJ, Forrest AP: Scottish adjuvant tamoxifen trial: a randomized study updated to 15 years. J Natl Cancer Inst 2001, 93:456–462.

    Article  PubMed  CAS  Google Scholar 

  25. Tormey DC, Gray R, Falkson HC: Postchemotherapy adjuvant tamoxifen therapy beyond five years in patients with lymph node-positive breast cancer. Eastern Cooperative Oncology Group. J Natl Cancer Inst 1996, 88:1828–1833.

    Article  PubMed  CAS  Google Scholar 

  26. Goss PE, Ingle JN, Martino S, et al.: A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med 2003, 349:1793–1802. This article will lead to a major change in practice in the near future.

    Article  PubMed  CAS  Google Scholar 

  27. Boccardo F, Rubagotti A, Amoroso D, et al.: Sequential tamoxifen and aminoglutethimide versus tamoxifen alone in the adjuvant treatment of postmenopausal breast cancer patients: results of an Italian cooperative study. J Clin Oncol 2001, 19:4209–4215.

    PubMed  CAS  Google Scholar 

  28. Love RR, Barden HS, Mazess RB, et al.: Effect of tamoxifen on lumbar spine bone mineral density in postmenopausal women after 5 years. Arch Intern Med 1994, 154:2585–2588.

    Article  PubMed  CAS  Google Scholar 

  29. Polychemotherapy for early breast cancer: an overview of the randomised trials. Early Breast Cancer Trialists’ Collaborative Group. Lancet 1998, 352:930–942. This paper is a bit old, but the latest meta-analysis (2000) hasn’t been published.

  30. National Institutes of Health Consensus Development Panel: National Institutes of Health Consensus Development Conference statement: adjuvant therapy for breast cancer, November 1–3, 2000. J Natl Cancer Inst Monogr 2001, 30:5–15. This paper is 3 years old, but it is still a very useful source of data and recommendations.

    Google Scholar 

  31. Extermann M, Balducci L, Lyman GH: What threshold for adjuvant therapy in older breast cancer patients? J Clin Oncol 2000, 18:1709–1717. A helpful tool to make individual decisions in the adjuvant treatment of older women. This paper is worth the initial understanding effort.

    PubMed  CAS  Google Scholar 

  32. Ravdin PM, Siminoff LA, Davis GJ, et al.: Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer. J Clin Oncol 2001, 19:980–991.

    PubMed  CAS  Google Scholar 

  33. Chia SK, Speers C, Kang A, et al.: The impact of new chemotherapeutic and hormonal agents on the survival of women with metastatic breast cancer (MBC) in a population based cohort [abstract]. Proc Am Soc Clin Oncol 2003, 22.

  34. Bonneterre J, Buzdar A, Nabholtz JM, et al.: Anastrozole is superior to tamoxifen as first-line therapy in hormone receptor positive advanced breast carcinoma. Cancer 2001, 92:2247–2258.

    Article  PubMed  CAS  Google Scholar 

  35. Mouridsen H, Gershanovich M, Sun Y, et al.: Phase III study of letrozole versus tamoxifen as first-line therapy of advanced breast cancer in postmenopausal women: analysis of survival and update of efficacy from the International Letrozole Breast Cancer Group. J Clin Oncol 2003, 21:2101–2109.

    Article  PubMed  CAS  Google Scholar 

  36. Bonneterre J, Roche H, Monnier A, et al.: Docetaxel vs 5-fluorouracil plus vinorelbine in metastatic breast cancer after anthracycline therapy failure. Br J Cancer 2002, 87:1210–1215.

    Article  PubMed  CAS  Google Scholar 

  37. Venturino A, Comandini D, Simoni C, et al.: Is salvage chemotherapy for metastatic breast cancer always effective and well tolerated? A phase II randomized trial of vinorelbine versus 5-fluorouracil plus leucovorin versus combination of mitoxantrone, 5-fluorouracil plus leucovorin. Breast Cancer Res Treat 2000, 60:195–200.

    Article  PubMed  CAS  Google Scholar 

  38. Nabholtz JM, Senn HJ, Bezwoda WR, et al.: Prospective randomized trial of docetaxel versus mitomycin plus vinblastine in patients with metastatic breast cancer progressing despite previous anthracycline-containing chemotherapy. 304 Study Group. J Clin Oncol 1999, 17:1413–1424.

    PubMed  CAS  Google Scholar 

  39. Procopio G, Bajetta E, Gattinoni L, et al.: Safety and activity of capecitabine in elderly patients (pts) with advanced breast cancer (ABC). Proc Am Soc Clin Oncol 2003, 22:759.

    Google Scholar 

  40. O’Shaughnessy J, Miles D, Vukelja S, et al.: Superior survival with capecitabine plus docetaxel combination therapy in anthracycline-pretreated patients with advanced breast cancer: phase III trial results. J Clin Oncol 2002, 20:2812–2823.

    Article  PubMed  CAS  Google Scholar 

  41. O’Shaughnessy J: Capecitabine and docetaxel in advanced breast cancer: analyses of a phase III comparative trial. Oncology (Huntingt) 2002, 16(Suppl 12):17–22.

    Google Scholar 

  42. Berruti A, Bitossi R, Gorzegno G, et al.: Time to progression in metastatic breast cancer patients treated with epirubicin is not improved by the addition of either cisplatin or lonidamine: final results of a phase III study with a factorial design. J Clin Oncol 2002, 20:4150–4159.

    Article  PubMed  CAS  Google Scholar 

  43. Nabholtz JM, Falkson C, Campos D, et al.: Docetaxel and doxorubicin compared with doxorubicin and cyclophosphamide as first-line chemotherapy for metastatic breast cancer: results of a randomized, multicenter, phase III trial. J Clin Oncol 2003, 21:968–975.

    Article  PubMed  CAS  Google Scholar 

  44. Slamon DJ, Leyland-Jones B, Shak S, et al.: Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med 2001, 344:783–792. This article established the role of trastuzumab in patients with breast cancer. It was also the first proof that a monoclonal antibody was clinically useful in cancer.

    Article  PubMed  CAS  Google Scholar 

  45. Robert N, Leyland-Jones B, Asmar L, et al.: Phase III comparative study of trastuzumab and paclitaxel with and without carboplatin in patients with Her2/neu positive advanced breast cancer. San Antonio Breast Cancer Symp 2002, 35. This paper shows a good improvement in outcome.

  46. Dees EC, O’Reilly S, Goodman SN, et al.: A prospective pharmacologic evaluation of age-related toxicity of adjuvant chemotherapy in women with breast cancer. Cancer Invest 2000, 18:521–529.

    PubMed  CAS  Google Scholar 

  47. Hurria A, Brogan K, Panageas K, et al.: Influence of change in cycle 1 to cycle 2 hematologic counts in predicting risk of toxicity in older breast cancer (BC) patients (pts) receiving adjuvant chemotherapy. Proc Am Soc Clin Oncol 2003, 22:730.

    Google Scholar 

  48. Balducci L, Lyman GH: Patients aged > or = 70 are at high risk for neutropenic infection and should receive hemopoietic growth factors when treated with moderately toxic chemotherapy. J Clin Oncol 2001, 19:1583–1585.

    PubMed  CAS  Google Scholar 

  49. Repetto L, Biganzoli L, Koehne CH, et al.: EORTC Cancer in the Elderly Task Force guidelines for the use of colony-stimulating factors in elderly patients with cancer. Eur J Cancer 2003, 39:2264–2272.

    Article  PubMed  CAS  Google Scholar 

  50. Lyman G, Kuderer N, Agboola O, Balducci L: Evidencebased use of colony-stimulating factors in elderly cancer patients. Cancer Control 2003, 10:487–499.

    PubMed  Google Scholar 

  51. Cella D, Dobrez D, Glaspy J: Control of cancer-related anemia with erythropoietic agents: a review of evidence for improved quality of life and clinical outcomes. Ann Oncol 2003, 14:511–519.

    Article  PubMed  CAS  Google Scholar 

  52. Extermann M, Chen H, Cantor AB, et al.: Predictors of tolerance to chemotherapy in older cancer patients: a prospective pilot study. Eur J Cancer 2002, 38:1466–1473.

    Article  PubMed  CAS  Google Scholar 

  53. Schrijvers D, Highley M, De Bruyn E, et al.: Role of red blood cells in pharmacokinetics of chemotherapeutic agents. Anticancer Drugs 1999, 10:147–153.

    Article  PubMed  CAS  Google Scholar 

  54. Loprinzi CL, Kugler JW, Sloan JA, et al.: Venlafaxine in management of hot flashes in survivors of breast cancer: a randomised controlled trial. Lancet 2000, 356:2059–2063.

    Article  PubMed  CAS  Google Scholar 

  55. Loprinzi CL, Sloan JA, Perez EA, et al.: Phase III evaluation of fluoxetine for treatment of hot flashes. J Clin Oncol 2002, 20:1578–1583.

    Article  PubMed  CAS  Google Scholar 

  56. Baselga J, Albanell J, Ruiz A, et al.: Phase II and tumor pharmacodynamic study of gefitinib (ZD1839) in patients with advanced breast cancer [abstract]. Proc Am Soc Clin Oncol 2003, 22:7.

    Google Scholar 

  57. Robertson JF, Gutteridge E, Cheung KL, et al.: Gefitinib (ZD1839) is active in acquired tamoxifen (TAM)-resistant oestrogen receptor (ER)-positive and ER-negative breast cancer: results from a phase II study [abstract]. Proc Am Soc Clin Oncol 2003, 22:7.

    Google Scholar 

  58. Jones RJ, Trigo J, Derosa F, et al.: A phase IB study of erlotinib plus capecitabine and docetaxel in metastatic breast cancer (MBC) [abstract]. Proc Am Soc Clin Oncol 2003, 22:45.

    Google Scholar 

  59. Hillan KJ, Koeppen HK, Tobin P, et al.: The role of VEGF expression in response to bevacizumab plus capecitabine in metastatic breast cancer (MBC) [abstract]. Proc Am Soc Clin Oncol 2003, 22:191.

    Google Scholar 

  60. Sparano JA, Bernardo P, Gradishar WJ, et al.: Randomized phase III trial of marimastat versus placebo in patients with metastatic breast cancer who have responding or stable disease after first-line chemotherapy: an Eastern Cooperative Oncology Group trial (E2196) [abstract]. Am Soc Clin Oncol 2002, 173.

  61. Kemeny MM, Peterson BL, Kornblith AB, et al.: Barriers to clinical trial participation by older women with breast cancer. J Clin Oncol 2003, 21:2268–2275.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Moffitt Cancer Center, 12902 Magnolia Drive, 33612, Tampa, FL, USA

    Martine Extermann MD

Authors
  1. Martine Extermann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Extermann, M. Management issues for elderly patients with breast cancer. Curr. Treat. Options in Oncol. 5, 161–169 (2004). https://doi.org/10.1007/s11864-004-0048-9

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-004-0048-9

Keywords

Search

Navigation