Optimizing Care of Elderly Women with Primary Breast Cancer

The incidence of primary breast cancer in elderly patients is increasing. However, their distinctive tumor biological characteristics, coupled with the different physical, psychosocial, and functional needs of elderly patients makes the management of breast cancer in this population complex. Currently, there are still no solid guidelines as to how we manage breast cancer in the elderly population as most of their treatments have been adapted from studies conducted in the younger population. Until strong evidence emerges to suggest otherwise, surgery, with adjuvant systemic therapy as appropriate, remains the main curative option in breast cancer and should be the treatment of choice. The more indolent tumor biology commonly seen in breast cancer in the elderly, coupled with competing causes of death may alter the goals of treatment. Primary endocrine therapy or radiotherapy may be an effective alternative in this population of patients, particularly in those who are frail or refuse surgery. A comprehensive geriatric assessment and quality of life assessment could identify pretreatment risk factors and guide clinical decision making, improving morbidity and prognosis. This should be achieved in a multidisciplinary setting, where the setup of a dedicated service for elderly primary breast cancer is the first step towards optimizing their treatment.