Treatment of breast cancer in older women.
BACKGROUND
Breast carcinoma management in the elderly often differs from the management in younger women and there is considerable controversy about what constitutes appropriate cancer care for older women. This controversy is reflected in the persistence of age-dependent variations in care over time, with older women being less likely to receive definitive care for breast cancer. There has been a significant increase in the last years in the number of studies conducted in older patients with breast cancer. Although available age-specific clinical trials data demonstrate that treatment efficacy is not modified by age, this evidence is limited by the lack of inclusion of substantial numbers of older women, particularly those of advanced age and those with comorbidities.


METHODS
The literature-based evidence of the last 10 years was extensively reviewed on the main issues concerning the treatment of breast cancer in older women.


RESULTS
Surgical treatment in older patients has evolved from avoidance to mastectomy to breast-conserving surgery, similarly to younger patients. Given its negative effect on the quality of life, in the last few years the role of adjuvant radiotherapy has been questioned in elderly patients with breast cancer. Adjuvant chemotherapy benefit in older patients applies mainly to Estrogen-receptor-negative patients, while in Estrogen-receptor-positive patients a major role is played by endocrine treatment. New "elderly-friendly" drugs, that can help clinicians to reduce toxicity, are now available for breast cancer.
Bernardi
Daniele
D
Division of Medical Oncology, Ospedale Civile, Vittorio Veneto, TV, Italy. dbernardi_tn@yahoo.com
Errante
Domenico
D
Gallligioni
Enzo
E
Crivellari
Diana
D
Bianco
Antonio
A
Salvagno
Luigi
L
Fentiman
Ian S
IS
D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D005060:Europe; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008408:Mastectomy / Q000379:methods*; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D021701:Sentinel Lymph Node Biopsy
D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal