Education And Debate

ABC of Breast Diseases: Breast cancer: treatment of elderly patients and uncommon conditions

BMJ 1994; 309 doi: (Published 12 November 1994) Cite this as: BMJ 1994;309:1292
  1. J M Dixon,
  2. J R C Sainsbury,
  3. A Rodger

    Treatment of elderly patients

    About 40% of all breast cancers occur in women aged over 70. The cancers that develop in older women are as aggressive as those seen in younger patients. Treatment with tamoxifen alone controls local disease in less than 30% of elderly patients at five years after diagnosis, which is not satisfactory since the average life expectancy of a 70 year old women is 14 years. Even when this treatment is restricted to patients with tumours that are oestrogen receptor positive, only half gain long term control of local disease.

    Management of elderly patients with breast cancer

    Tumour stage and size Treatment options T1 or T2 <=4 cm size, N0-1, M0 Wide local excision, node sampling, and radiotherapy or Mastectomy, node clearance, and adjuvant tamoxifen T2 >4 cm or T3, N0-1, M0: Oestrogen receptor: Positive Mastectomy, node clearance, and adjuvant tamoxifen or Tamoxifen and then, if tumour regresses, wide local excision, node sampling, and radiotherapy Unknown, negative, or Mastectomy, node clearance, and adjuvant no response to tamoxifen tamoxifen T4, N2, M0: Oestrogen receptor: Positive Tamoxifen Unknown, negative, or Radical radiotherapy or no response to Mastectomy and radiotherapy tamoxifen Possibly chemotherapy Any T, any N, M1: Oestrogen receptor: Positive or unknown Tamoxifen and symptomatic treatment Negative Symptomatic treatment and possibly low dose epirubicin or mitozantrone Very elderly or infirm Tamoxifen patients

    Elderly women with breast cancer should be treated in a similar way to younger patients. Few patients are truly unfit for surgery because widelocal excision or even mastectomy can, if necessary, be performed under local anaesthesia with sedation. There is no evidence to suggest that elderly patients cannot tolerate radiotherapy as well as younger patients, and when radiotherapy is given it should be given in a radical dose. …

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