The International Society of Geriatric Oncology (SIOG) has recently published guidelines on the management of breast cancer in the elderly. This overview summarizes the most important aspects and recommendations. Breast cancer is the most commonly diagnosed cancer and leading cause of cancer mortality in women worldwide. Nearly one-third of the global total of breast cancer cases occurs in patients >65 years of age and in more developed countries it accounts for >40% of cases.
Advanced age at the diagnosis of breast cancer is associated with more favourable tumour biology, as indicated by increased hormone sensitivity, attenuated HER2/neu overexpression, and lower grades and proliferative indices. Elderly patients, however, are more likely to present with larger and more advanced tumours, and recent reports suggest that lymph node involvement increases with age. Elderly patients are less likely to be treated according to accepted treatment guidelines and undertreatment can, as a consequence, have a strong negative impact on survival. Despite the fact that breast cancer occurs mainly in elderly patients, this population is significantly underrepresented in clinical trials.
Collaboration with geriatricians and comprehensive geriatric assessment are of paramount importance in detecting unaddressed problems, improving functional status and, possibly, survival in elderly patients with cancer. Because comorbidities and functional status significantly impact on prognosis and treatment choice, thorough consideration must be given to the overall health of elderly patients. A significant proportion of patients older then 70 years with operable breast cancer die of non-cancer-related causes. Age alone, however, should not be a barrier to treatment.