Treatment of carcinoma of the breast in the older geriatric patient.

With recent changes in the management of carcinoma of the breast and a population that is increasingly aging, it behooves us to determine the most appropriate treatment of carcinoma of the breast in the elderly. We reviewed the records of 150 women 80 years of age or greater who were diagnosed between 1970 and 1980 at the Massachusetts General Hospital as having carcinoma of the breast. In these selected patients, treatment with operation or radiotherapy was well tolerated. Of the 103 patients who had mastectomies, only one patient died during the postoperative period. The complication rate from mastectomy was similar to that reported for younger patients. All of the patients who began radiotherapy completed their courses of treatment. Complications from radiotherapy were generally transient and easily tolerated. Five year actuarial survival rates for patients with Stages I and II disease were similar for those receiving primary radiation therapy (67 per cent) or modified radical mastectomy (65 per cent). However, the comparable survival rate for those treated with lumpectomy alone was only 39 per cent. Local and regional failures occurred with lumpectomy, total mastectomy or primary radiation therapy, but not with modified radical mastectomy. We conclude that age alone should not dictate the treatment for carcinoma of the breast. An otherwise healthy elderly woman should be offered the same treatment options for the treatment of carcinoma of the breast as those offered to younger patients.