Skip to main content
SpringerLink
Log in

Breast Cancer in the Elderly

  • Chapter
Management of Breast Diseases

  • 1892 Accesses

Abstract

Breast cancer is the most common cancer in American women, and increasing age is the major risk factor for breast cancer. During 2001–2005, women aged 75–79 years had the highest breast cancer incidence rate of 453.1 per 100,000 [1]. Incidence and mortality data based on the Surveillance, Epidemiology, and End Results (SEER) program are shown in Fig. 26.1. The median age at diagnosis of breast cancer in the United States is 61 years, and most deaths from breast cancer now occur in women aged 65 years and older [2]. A lower incidence of breast cancer is noted in women of the age 80 years or older and may be due to lower rates of screening, detection of cancers before 80, or incomplete detection. Older women are frequently diagnosed with breast cancer at a higher stage, but survival for Stage I and Stage II breast cancer is similar across age groups [3–5]. The majority of breast cancers in younger and older patients are Stage I or Stage II. About 10% of older patients are likely to present with Stage III or Stage IV disease and some with unknown stage at diagnosis [6].

Breast cancer incidence and mortality by age for 2001–2005 from surveillance, epidemiology, and end results (SEER) database [1]

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Schairer C, Mink PJ, Carroll L, Devesa SS (2004) Probabilities of death from breast cancer and other causes among female breast cancer patients. J Natl Cancer Inst. 96:1311–21

    Article  PubMed  Google Scholar 

  2. Herbsman H, Feldman J, Seldera J, Gardner B, Alfonso AE (1981) Survival following breast cancer surgery in the elderly. Cancer. 47:2358–63

    Article  CAS  PubMed  Google Scholar 

  3. Lyman GH, Lyman S, Balducci L, Kuderer N, Reintgen D, Cox C et al (1996) Age and the risk of breast cancer recurrence. Cancer Control. 3:421–7

    PubMed  Google Scholar 

  4. Masetti R, Antinori A, Terribile D, Marra A, Granone P, Magistrelli P et al (1996) Breast cancer in women 70 years of age or older. J Am Geriatrics Soc. 44:390–3

    CAS  Google Scholar 

  5. Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK. Yates JW (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA. 285:885–92

    Article  CAS  PubMed  Google Scholar 

  6. Hebert-Croteau N, Brisson J, Latreille J, Blanchette C, Deschenes L (1999) Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women. Cancer. 85(5):1104–13

    Article  CAS  PubMed  Google Scholar 

  7. Hebert-Croteau N, Brisson J, Latreille J, Rivard M, Abdelaziz N, Martin G (2004) Compliance with consensus recommendations for systemic therapy is associated with improved survival of women with node-negative breast cancer. J Clin Oncol. 22:3685–93

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  9. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS (1999) Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 341:2061–7

    Article  CAS  PubMed  Google Scholar 

  10. Sateren WB, Trimble EL, Abrams J, Brawley O, Breen N et al (2002) How sociodemographics, presence of oncology specialists, and hospital cancer programs affect accrual to cancer treatment trials. J Clin Oncol. 20:2109–17

    Article  PubMed  Google Scholar 

  11. Kemeny MM, Peterson BL, Kornblith AB, Muss HB, Wheeler J, Levine E et al (2003) Barriers to clinical trial participation by older women with breast cancer. J Clin Oncol. 21:2268–75

    Article  PubMed  Google Scholar 

  12. Trimble EL, Carter CL, Cain D, Freidlin B, Ungerleider RS, Friedman MA (1994) Representation of older patients in cancer treatment trials. Cancer. 74:2208–14

    Article  CAS  PubMed  Google Scholar 

  13. Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW (2001) Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA. 285:885–92

    Article  CAS  PubMed  Google Scholar 

  14. Satariano WA, Ragland DR (1994) The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med. 120:104–10

    CAS  PubMed  Google Scholar 

  15. Extermann M, Hurria A (2007) Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol. 25:1824–31

    Article  PubMed  Google Scholar 

  16. Dittus K, Muss HB (2007) Management of the frail elderly with breast cancer. Oncology (Williston Park). 21:1727–34

    Google Scholar 

  17. Maas HA, Janssen-Heiinen ML, Olde Rikkert MG, Machteld Wymenga AN (2007) Comprehensive Geriatric assessment and its clinical impact in oncology. Eur J Cancer. 43:2161–9

    Article  PubMed  Google Scholar 

  18. Saliba D, Elliott M, Rubenstein LZ, Solomon DH, Young RT, Kamberg CJ et al (2001) The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community. J Am Geriatr Soc. 49:1691–9

    Article  CAS  PubMed  Google Scholar 

  19. Hurria A, Gupta S, Zauderer M, Zuckerman EL, Cohen HJ, Muss H et al (2005) Developing a cancer-specific geriatric assessment: a feasibility study. Cancer. 104:1998–2005

    Article  PubMed  Google Scholar 

  20. Rodin MB, Mohile SG (2007) A practical approach to geriatric assessment in oncology. J Clin Oncol. 25:1936–44

    Article  PubMed  Google Scholar 

  21. Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S et al (2005) Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol Hematol. 55:241–52

    Article  PubMed  Google Scholar 

  22. La Vecchia C, Negri E, Franceschi S, Talamini R, Bruzzi P, Palli D et al (1997) Body mass index and post-menopausal breast cancer: an age-specific analysis. Br J Cancer. 75:441–4

    PubMed  Google Scholar 

  23. Senie RT, Rosen PP, Rhodes P, Lesser ML, Kinne DW (1992) Obesity at diagnosis of breast carcinoma influences duration of disease-free survival. Ann Intern Med. 116: 26–32

    CAS  PubMed  Google Scholar 

  24. Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM et al (1998) Tamoxifen for prevention of breast cancer: report of the national surgical adjuvant breast and bowel project P-1 Study [see comments]. J Natl Cancer Inst. 90:1371–88

    Article  CAS  PubMed  Google Scholar 

  25. Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN et al (2006) Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA. 295:2727–41

    Article  CAS  PubMed  Google Scholar 

  26. Gail MH, Costantino JP, Bryant J, Croyle R, Freedman L, Helzlsouer K et al (1999) Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer [see comments] [published erratum appears in J Natl Cancer Inst 2000 Feb 2;92(3):275]. J Natl Cancer Inst. 91:1829–46

    Article  CAS  PubMed  Google Scholar 

  27. Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN et al (2006) Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP study of tamoxifen and raloxifene (STAR) P-2 trial. JAMA. 295:2727–41

    Article  CAS  PubMed  Google Scholar 

  28. Humphrey LL, Helfand M, Chan BK, Woolf SH (2002) Breast cancer screening: a summary of the evidence for the U.S. preventive services task force. Ann Intern Med. 137:347–60

    PubMed  Google Scholar 

  29. Nystrom L, Rutqvist LE, Wall S, Lindgren A, Lindqvist M, Ryden S et al (1993) Breast cancer screening with mammography: overview of Swedish randomised trials. Lancet. 341:973–8

    Article  CAS  PubMed  Google Scholar 

  30. Andersson I, Aspegren K, Janzon L, Landberg T, Lindholm K, Linell F et al (1988) Mammographic screening and mortality from breast cancer: the Malmo mammographic screening trial. BMJ. 297:943–8

    Article  CAS  PubMed  Google Scholar 

  31. Tabar L, Fagerberg G, Chen HH, Duffy SW, Smart CR, Gad A et al (1995) Efficacy of breast cancer screening by age. New results from the Swedish two-county trial. Cancer. 75:2507–17

    Article  CAS  PubMed  Google Scholar 

  32. Badgwell BD, Giordano SH, Duan ZZ, Fang S, Bedrosian I, Kuerer HM et al (2008) Mammography before diagnosis among women age 80 years and older with breast cancer. J Clin Oncol. 26:2482–8

    Article  PubMed  Google Scholar 

  33. Audisio RA, Bozzetti F, Gennari R, Jaklitsch MT, Koperna T, Longo WE et al (2004) The surgical management of elderly cancer patients; recommendations of the SIOG surgical task force. Eur J Cancer. 40:926–38

    Article  CAS  PubMed  Google Scholar 

  34. Kemeny MM (2004) Surgery in older patients. Semin Oncol. 31:175–84

    Article  PubMed  Google Scholar 

  35. Figueiredo MI, Cullen J, Hwang YT, Rowland JH, Mandelblatt JS (2004) Breast cancer treatment in older women: does getting what you want improve your long-term body image and mental health? J Clin Oncol. 22:4002–9

    Article  PubMed  Google Scholar 

  36. Hind D, Wyld L, Beverley CB, Reed MW. Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus). Cochrane Database Syst Rev. 2006;CD004272

    Google Scholar 

  37. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans E et al (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 366:2087–106

    CAS  PubMed  Google Scholar 

  38. Hughes KS, Schnaper LA, Berry D, Cirrincione C, McCormick B, Shank B 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: 971–7

    Article  CAS  PubMed  Google Scholar 

  39. Hughes KS, Schnaper LA, Berry DA, Hodgson L, Cirrincione C, McCormick B, Shank B, Champion LA, Smith BL, Shapiro C, Muss HB, Winer E, Hudis C, Wood W, Henderson IC, Sugarbaker D, Norton L. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer: a report of further follow-up. Br Ca Res Treat. 2006;100:S8. Ref Type: abstr

    Google Scholar 

  40. Mundt AJ (2000) Radiation therapy and the elderly. In: Hunter CP, Johnson KA, Muss HB (eds) Cancer in the elderly. Dekker, New York, pp 187–216

    Google Scholar 

  41. Gennan R, Rotmensz N, Perego E, dos SG, Veronesi U. Sentinel node biopsy in elderly breast cancer patients. Surg Oncol. 2004;13:193–6

    Article  Google Scholar 

  42. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 365:1687–717

    Article  CAS  Google Scholar 

  43. Diab SG, Elledge RM, Clark GM (2000) Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst. 92:550–6

    Article  CAS  PubMed  Google Scholar 

  44. Grann VR, Troxel AB, Zojwalla NJ, Jacobson JS, Hershman D, Neugut AI (2005) Hormone receptor status and survival in a population-based cohort of patients with breast carcinoma. Cancer. 103:2241–51

    Article  CAS  PubMed  Google Scholar 

  45. Crivellari D, Aapro M, Leonard R, von Minckwitz G, Brain E, Goldhirsch A et al (2007) Breast cancer in the elderly. J Clin Oncol. 25:1882–90

    Article  PubMed  Google Scholar 

  46. Toikkanen S, Kujari H (1989) Pure and mixed mucinous carcinomas of the breast: a clinicopathologic analysis of 61 cases with long-term follow-up. Hum Pathol. 20:758–64

    Article  CAS  PubMed  Google Scholar 

  47. Wildiers H, Kunkler I, Biganzoli L, Fracheboud J, Vlastos G, Bernard-Marty C et al (2007) Management of breast cancerinelderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol. 8:1101–15

    Article  PubMed  Google Scholar 

  48. Paik S, Shak S, Tang G, Kim C, Baker J, Cronin M et al (2004) A multigene assay to predict recurrence of tamoxifentreated, node-negative breast cancer. N Engl J Med. 351:2817–26

    Article  CAS  PubMed  Google Scholar 

  49. Ingle JN (2005) Endocrine therapy trials of aromatase inhibitors for breast cancer in the adjuvant and prevention settings. Clin Cancer Res. 11:900s–5s

    CAS  PubMed  Google Scholar 

  50. Winer EP, Hudis C, Burstein HJ, Wolff AC, Pritchard KI, Ingle JN et al (2005) American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: status report 2004. J Clin Oncol. 23:619–29

    Article  CAS  PubMed  Google Scholar 

  51. Forbes JF, Cuzick J, Buzdar A, Howell A, Tobias JS, Baum M (2008) Effect of anastrozole and tamoxifen as adjuvant treatment for early stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol. 9:45–53

    Article  PubMed  CAS  Google Scholar 

  52. Coombes RC, Kilburn LS, Snowdon CF, Paridaens R, Coleman RE, Jones SE et al (2007) Survival and safety of exemestane versus tamoxifen after 2–3 years’ tamoxifen treatment (Intergroup Exemestane Study): a randomized controlled trial. Lancet. 369:559–70

    Article  CAS  PubMed  Google Scholar 

  53. Goss PE, Ingle JN, Martino S, Robert NJ, Muss HB, Piccart MJ et al (2005) Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. J Natl Cancer Inst. 97:1262–71

    Article  CAS  PubMed  Google Scholar 

  54. Muss HB, Tu D, Ingle JN, Martino S, Robert NJ, Pater JL et al Efficacy, toxicity, and quality of life in older women with early-stage breast cancer treated with letrozole or placebo after 5 years of tamoxifen: NCIC CTG intergroup trial MA.17. J Clin Oncol. 2008;26:1956–64

    Article  CAS  PubMed  Google Scholar 

  55. Muss HB, Tu D, Ingle JN, Martino S, Robert NJ, Pater JL et al Efficacy, toxicity, and quality of life in older women with early-stage breast cancer treated with letrozole or placebo after 5 years of tamoxifen: NCIC CTG intergroup trial MA.17. J Clin Oncol. 2008;26:1956–64

    Article  CAS  PubMed  Google Scholar 

  56. Hillner BE, Ingle JN, Chlebowski RT, Gralow J, Yee GC, Janjan NA et al (2003) American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in women with breast cancer. J Clin Oncol. 21:4042–57

    Article  CAS  PubMed  Google Scholar 

  57. Giordano SH, Duan Z, Kuo YF, Hortobagyi GN, Goodwin JS (2006) Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol. 24:2750–6

    Article  PubMed  Google Scholar 

  58. Jones SE, Savin MA, Holmes FA, O’Shaughnessy JA, Blum JL, Vukelja S et al (2006) Phase III trial comparing doxorubicin plus cyclophosphamide with docetaxel plus cyclophosphamide as adjuvant therapy for operable breast cancer. J Clin Oncol. 24:5381–7

    Article  CAS  PubMed  Google Scholar 

  59. Muss HB, Woolf S, Berry D, Cirrincione C, Weiss RB, Budman D et al (2005) Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA. 293:1073–81

    Article  CAS  PubMed  Google Scholar 

  60. Muss HB, Berry DA, Cirrincione C, Budman DR, Henderson IC, Citron ML et al (2007) Toxicity of older and younger patients treated with adjuvant chemotherapy for node-positive breast cancer: the cancer and leukemia group B experience. J Clin Oncol. 25:3699–704

    Article  CAS  PubMed  Google Scholar 

  61. Hortobagyi GN (2005) Trastuzumab in the treatment of breast cancer. N Engl J Med. 353:1734–6

    Article  CAS  PubMed  Google Scholar 

  62. Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE et al (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 353:1673–84

    Article  CAS  PubMed  Google Scholar 

  63. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, Goldhirsch A, Untch M, Smith I et al (2005) Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 353:1659–72

    Article  CAS  PubMed  Google Scholar 

  64. Telli ML, Hunt SA, Carlson RW, Guardino AE (2007) Trastuzumab-related cardiotoxicity: calling into question the concept of reversibility. J Clin Oncol. 25:3525–33

    Article  CAS  PubMed  Google Scholar 

  65. Slamon D, Eiermann W, Robert N, and et al 2nd interim analysis phase III randomized trial comparing doxorubicin and cyclophosphamide, followed by docetaxel with doxorubicin and cyclophosphamide, followed by docetaxel and trastuzumab with docetaxel, carboplatin and trastuzumab in Her2neu positive early breast cancer patients. Br Ca Res Treat. 2006. Ref Type: abstr

    Google Scholar 

  66. Muss HB, Woolf S, Berry D, Cirrincione C, Weiss RB, Budman D et al (2005) Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA. 293:1073–81

    Article  CAS  PubMed  Google Scholar 

  67. Berry DA, Cirrincione C, Henderson IC, Citron ML, Budman DR, Goldstein LJ et al (2006) Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA. 295:1658–67

    Article  CAS  PubMed  Google Scholar 

  68. Group Early Breast Cancer Trialists’ Collaborative, Clarke M (2008) Coates AS, Darby SC, Davies C. Gelber RD et al Adjuvant chemotherapy in oestrogen-receptor-poor breast cancer: patient-level meta-analysis of randomised trials. Lancet. 371:29–40

    Article  CAS  Google Scholar 

  69. Muss HB, Berry DL, Cirrincione C, Theodoulou M, Mauer A, Cohen H, Partridge AH, Norton L, Hudis CA, Winer EP, North American Breast Cancer Intergroup. Standard chemotherapy (CMF or AC) versus capecitabine in early-stage breast cancer (BC) patients aged 65 and older: results of CALGB/CTSU 49907. J Clin Oncol 26:8s. 5-20-2008. Ref Type: abstr

    Google Scholar 

  70. Miles D, von Minckwitz G, Seidman AD (2002) Combination versus sequential single-agent therapy in metastatic breast cancer. Oncologist. 7(Suppl 6):13–9

    CAS  PubMed  Google Scholar 

  71. Christman K, Muss HB, Case LD, Stanley V (1992) Chemotherapy of metastatic breast cancer in the elderly. The Piedmont Oncology Association experience [see comment]. JAMA. 268:57–62

    Article  CAS  PubMed  Google Scholar 

  72. Ibrahim NK, Frye DK, Buzdar AU, Walters RS, Hortobagyi GN (1996) Doxorubicin-based chemotherapy in elderly patients with metastatic breast cancer. Tolerance and outcome. Arch Intern Med. 156:882–8

    Article  CAS  PubMed  Google Scholar 

  73. Miller K, Wang M, Gralow J, Dickler M, Cobleigh M, Perez EA et al (2007) Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med. 357:2666–76

    Article  CAS  PubMed  Google Scholar 

  74. Geyer CE, Forster J, Lindquist D, Chan S, Romieu CG, Pienkowski T et al (2006) Lapatinib plus capecitabine for HER2-positive advanced breast cancer. N Engl J Med. 355:2733–43

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hematology/Oncology Unit, University of Vermont and Vermont Cancer Center, 89 Beaumont Avenue, Given Building E214, Burlington, VT, 05405, USA

    Madhuri V. Vithala & Hyman B. Muss

  2. University of North Carolina, Chapel Hill, NC, 27705, USA

    Madhuri V. Vithala & Hyman B. Muss

Authors
  1. Madhuri V. Vithala
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyman B. Muss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Madhuri V. Vithala .

Editor information

Editors and Affiliations

  1. Breast Care Center National Naval Medical Center, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD, 20814, USA

    Ismail Jatoi (Head) (Head)

  2. Women’s Hospital, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany

    Manfred Kaufmann (Breast Unit Director) (Breast Unit Director)

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Vithala, M.V., Muss, H.B. (2010). Breast Cancer in the Elderly. In: Jatoi, I., Kaufmann, M. (eds) Management of Breast Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69743-5_26

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-69743-5_26

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-69742-8

  • Online ISBN: 978-3-540-69743-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation