The role of surgery in the management of older women with breast cancer.
Standard treatment for early breast cancer usually involves multi-modality treatment with a combination of surgery and one or more adjuvant therapies. These may include chemotherapy, radiotherapy, endocrine therapy and Trastuzumab. The treatment schedule for an individual patient may be complex, prolonged and associated with significant morbidity. The benefits of such regimens are clear to see in the improving mortality statistics for this breast cancer. However, such protocols may not appropriate for all women. Older women (over 70 years) have increasing rates of co-morbidities, reduced life expectancy and generally have more favourable breast cancer disease biology. Competing causes of death mean that they are less likely to die of their breast cancer, stage for stage, than a younger woman. In addition, their tolerance to some of the therapies is reduced which increases treatment related morbidity and reduces the risk to benefit ratio. It may therefore be appropriate to modify treatment protocols in selected older women. This should be done in consultation with the multi-disciplinary team with input from specialists in Medicine for the Elderly. The views and wishes of the patient should be respected during these discussions. This article reviews these issues.
Wyld
Lynda
L
Academic Unit of Surgical Oncology, University of Sheffield, School of Medicine and Biomedical Sciences, Beech Hill Road, Sheffield S10 2RX, United Kingdom.
Reed
Malcolm
M
D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000379:methods; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D016462:Mammaplasty / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D016019:Survival Analysis; D013997:Time Factors
D018931:Antineoplastic Agents, Hormonal