What are the considerations for breast cancer in the elderly?

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Last updated: May 7, 2025 • View editorial policy

From the Guidelines

Breast cancer treatment in elderly patients should be tailored to their biological age, considering less aggressive regimens in frail patients, and a geriatric assessment should be carried out before making treatment decisions. For elderly women with breast cancer, treatment should be individualized based on overall health status, life expectancy, and tumor characteristics rather than age alone 1. Standard treatment options include surgery (lumpectomy or mastectomy), radiation therapy, hormonal therapy (such as tamoxifen or aromatase inhibitors like anastrozole, letrozole, or exemestane for 5-10 years in hormone-receptor positive cases), chemotherapy, and targeted therapies when appropriate.

Some key considerations in the management of breast cancer in elderly patients include:

  • The use of a standard multidrug regimen for chemotherapy in patients suitable for standard treatment 2, 1
  • The consideration of less aggressive approaches, such as primary endocrine therapy without surgery, for frail elderly patients with hormone-positive tumors 3, 4
  • The importance of side effect management, particularly for bone health during aromatase inhibitor therapy, which may require calcium and vitamin D supplementation 3
  • The need for a personalized approach, taking into account the patient's comorbidities and potential differences in treatment toxicities and breast cancer biology with age 2, 1

In terms of specific treatment recommendations, omission of radiation therapy can be considered for patients 70 years or older with stage I estrogen receptor-positive breast cancer who undergo a lumpectomy with negative margins and are likely to complete 5 years of endocrine therapy 4, 1. Additionally, a geriatric assessment should be carried out before making treatment decisions to ensure that the treatment plan is tailored to the patient's individual needs and abilities 2, 1.

From the FDA Drug Label

The median age of patients in all studies of first-line and second-line treatment of metastatic breast cancer was 64 to 65 years. About 1/3 of the patients were greater than or equal to 70 years old. In the first-line study, patients greater than or equal to 70 years of age experienced longer time to tumor progression and higher response rates than patients less than 70 In the extended adjuvant setting (MA-17), more than 5,100 postmenopausal women were enrolled in the clinical study. In total, 41% of patients were aged 65 years or older at enrollment, while 12% were 75 or older In the extended adjuvant setting, no overall differences in safety or efficacy were observed between these older patients and younger patients, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out In the adjuvant setting (BIG 1-98), more than 8,000 postmenopausal women were enrolled in the clinical study. In total, 36% of patients were aged 65 years or older at enrollment, while 12% were 75 or older. More adverse reactions were generally reported in elderly patients irrespective of study treatment allocation However, in comparison to tamoxifen, no overall differences with regards to the safety and efficacy profiles were observed between elderly patients and younger patients.

Key Points:

  • The median age of patients in breast cancer studies was 64 to 65 years.
  • About 1/3 of the patients were greater than or equal to 70 years old.
  • Patients greater than or equal to 70 years of age experienced longer time to tumor progression and higher response rates.
  • No overall differences in safety or efficacy were observed between older patients and younger patients.
  • More adverse reactions were generally reported in elderly patients.

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From the Research

Breast Cancer in the Elderly

  • Breast cancer is a common malignancy in Western countries, and its management is determined by various factors, including HER2, HR, ER, and PR status 6.
  • Elderly breast cancer patients are often denied adjuvant chemotherapy due to their age, despite the potential benefits of treatment 7.
  • Comprehensive geriatric assessment (CGA) is a tool used to evaluate the vulnerability of elderly patients and inform treatment decisions, taking into account physical function, comorbidity, cognitive function, and other factors 8.

Treatment and Outcomes

  • Adjuvant chemotherapy is underused in "fit" elderly patients with breast cancer, with only 69% and 42% of Balducci's class I and II patients receiving appropriate treatment, respectively 7.
  • CGA can help identify patients at risk of toxicity and predict survival, with the number of geriatric conditions correlating with grade 3-4 chemotherapy-related toxicity 9.
  • Fit patients are more likely to undergo primary breast surgery, axillary surgery, and adjuvant chemotherapy for high-risk disease, highlighting the importance of CGA in treatment planning 10.

Comprehensive Geriatric Assessment

  • CGA is a valuable tool in the management of elderly breast cancer patients, allowing for the identification of health problems and the prediction of adverse events 8.
  • The use of CGA in routine clinical practice requires establishment of a consensus regarding survey methods, evaluation scales, and the use of results in decision-making 8.
  • Studies have shown that CGA can be used to determine fitness for treatment, with fit patients being more likely to receive radical curative treatments 10.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.