title: Management of early breast cancer in older women: from screening to treatment.
abstract: BACKGROUND
  Breast cancer is a common condition. It is a leading cause of death among women, and its incidence increases with age. Aging of the population and improvement of the quality of life of elders make it a major public health issue. We reviewed the literature to try to determine the management of breast cancer in older women.
  
  
  METHODS
  We conducted a narrative review by literature searches using key words "breast cancer", "elderly and older", and "women" in Pubmed, Scopus, and Google Scholar. The aim of this review is to summarize the management of early breast cancer in older women by discussing the controversies of screening in older women. Then, we try to define the optimal strategy for these women, either surgery alone or primary endocrine therapy. We also discuss the indications of lymph node dissection, and we evaluate the benefit of adjuvant radiotherapy, chemotherapy, and the anti HER2 treatment for these women.
  
  
  RESULTS
  More than 50% of patients with breast cancer are 65 years or older, and around 30% are more than 70 years old. Most randomized trials did not include older women. Hence, the treatment of breast cancer in older patients is based on the management provided to younger women. Regardless of age, the treatment must aim for the best efficiency. Advanced age in itself should not be a limitation to treatment. There are no standard guidelines set for elderly patients. Surgical treatment for older patients evolved to avoid mastectomy, and conservative mammary surgery was proposed, similar to that used in younger patients. The proportion of elderly patients receiving adjuvant radiotherapy is increasing. The role of adjuvant radiotherapy in older patients with breast cancer was analyzed. Adjuvant chemotherapy is beneficial to women with hormone receptor-negative tumors. In those with hormone receptor-positive tumors, adjuvant chemotherapy in association to trastuzumab is beneficial for HER2-positive tumors, and for women with HER2-negative tumors adjuvant hormonal therapy is a very good option.
  
  
  CONCLUSIONS
  Breast cancer is common in older women. This population requires particular and adapted management. It is essential for older patients to be included in new clinical trials for individualized treatment recommendation.
authors.affiliation: Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
authors.forename: Fadwa
authors.initials: F
authors.lastname: Elomrani
authors.affiliation: Department of Onco Hematology, Military Hospital Mohamed V, Rabat, Morocco.
authors.forename: Maryem
authors.initials: M
authors.lastname: Zine
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, Rabat, Morocco.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Afif
authors.affiliation: Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
authors.forename: Saad
authors.initials: S
authors.lastname: L'annaz
authors.affiliation: Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
authors.forename: Imane
authors.initials: I
authors.lastname: Ouziane
authors.affiliation: Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
authors.forename: Hind
authors.initials: H
authors.lastname: Mrabti
authors.affiliation: Department of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
authors.forename: Hassan
authors.initials: H
authors.lastname: Errihani
keywords: breast cancer; chemotherapy; elderly women; hormonal therapy; radiotherapy; surgery