Breast cancer in elderly

Abstract

A typical age of the czech patient with breast cancer is 60-69 years. Epidemiological studies confirmed that breast cancer in older women usually had more favorable biological characteristics, such as high percentage of luminal A types. Despite the general opinion that breast cancer in older age is an indolent disease, there is clearly evidence of higher disease-specific mortality in comparison with younger patients. This fact is probably related to the use of less aggressive drug therapy. In older patients, the treatment decision should begin with an estimate of life expectancy, an assessment of the general condition, and proceed to discussion of the benefits and risks of treatment. The problem of treatment in the elderly is that there is little evidence on the optimal treatment decisions. The American Society of Clinical Oncology guidelines for geriatric oncology were published in 2018. The guidelines provide recommendations on the use of clinical assessment tools and decision making models for older patients. Clinicians should use results of the evaluation when recommending individual therapeutic plan that can be adjusted in the case of older patients. In indicated cases, surgery, radiation as well as drug therapy can be modified to become less aggressive. Particular candidates for less radical therapy are vulnerable patients with a short life expectancy or with favorable biological characteristics of the tumor.