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