Management of breast cancer in older adults
Introduction Increasing age is a major risk factor for the development of breast cancer. While approximately 1 in 233 women are diagnosed with breast cancer in the fourth decade of life, the risk increases to 1 in 27 in the seventh decade (Figure 7.1). Thus over half the women diagnosed with breast cancer in the United States annually are 65 years of age and older. With the aging of the population in the United States, and given that breast cancer represents the second leading cause of cancer death for women in the United States, optimizing management of this disease in this population of patients is of utmost importance. As a generality, less aggressive tumor biologic characteristics are associated with breast cancers in older women. For instance, several prognostic features of tumors in older women often indicate favorable prognosis: steroid receptor positivity, lower proliferative rate, diploid (vs. aneuploid), and low histologic grade. In addition, p53 is more often normal, and less expression of epidermal growth factor receptor and c-erbB2 are observed in this population of patients. Though ductal histology remains the most common regardless of age, the more indolent histologies, such as tubular, mucinous, and papillary, are observed with greater frequency in older patients than in younger patients. Despite these more favorable tumor characteristics, breast cancer survival is poorer and breast cancer–specific mortality is greater for women over age 75 as compared with younger patients.
