Julia Frebault1, Carmen Bergom2, Amanda L Kong3. 1. Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA. 2. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, USA. 3. Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI, 53226, USA. akong@mcw.edu.
Abstract
PURPOSE OF REVIEW: Breast cancer incidence and mortality increase with age. Older patients (≥ 70) are often excluded from studies. Due to multiple factors, it is unclear whether this population is best-treated using standard guidelines. Here, we review surgical management in older women with breast cancer. RECENT FINDINGS: Geriatric assessments can guide treatment recommendations and aid in predicting survival and quality of life. Surgery remains a principal component of breast cancer treatment in older patients, though differences exist compared with younger women, including higher mastectomy rates and evidence-based support of omission of post-lumpectomy radiation or axillary dissection in subsets of patients. In those forgoing surgical management, there is increased use of endocrine therapy. Hospice is also a valuable element of end-of-life care. Physicians should utilize geriatric assessment to make treatment recommendations for older breast cancer patients, including omission of radiation therapy, alterations to standard surgeries, or enrollment in hospice care.
PURPOSE OF REVIEW: Breast cancer incidence and mortality increase with age. Older patients (≥ 70) are often excluded from studies. Due to multiple factors, it is unclear whether this population is best-treated using standard guidelines. Here, we review surgical management in older women with breast cancer. RECENT FINDINGS: Geriatric assessments can guide treatment recommendations and aid in predicting survival and quality of life. Surgery remains a principal component of breast cancer treatment in older patients, though differences exist compared with younger women, including higher mastectomy rates and evidence-based support of omission of post-lumpectomy radiation or axillary dissection in subsets of patients. In those forgoing surgical management, there is increased use of endocrine therapy. Hospice is also a valuable element of end-of-life care. Physicians should utilize geriatric assessment to make treatment recommendations for older breast cancerpatients, including omission of radiation therapy, alterations to standard surgeries, or enrollment in hospice care.
Entities:
Keywords:
Breast cancer; Geriatric assessment; Geriatric oncology; Lumpectomy; Older patients; Surgery
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: A Howell; J Cuzick; M Baum; A Buzdar; M Dowsett; J F Forbes; G Hoctin-Boes; J Houghton; G Y Locker; J S Tobias Journal: Lancet Date: 2005 Jan 1-7 Impact factor: 79.321
Authors: Kevin S Hughes; Lauren A Schnaper; Donald Berry; Constance Cirrincione; Beryl McCormick; Brenda Shank; Judith Wheeler; Lorraine A Champion; Thomas J Smith; Barbara L Smith; Charles Shapiro; Hyman B Muss; Eric Winer; Clifford Hudis; William Wood; David Sugarbaker; I Craig Henderson; Larry Norton Journal: N Engl J Med Date: 2004-09-02 Impact factor: 91.245
Authors: D Pope; H Ramesh; R Gennari; G Corsini; M Maffezzini; H J Hoekstra; D Mobarak; K Sunouchi; A Stotter; C West; R A Audisio Journal: Surg Oncol Date: 2006-12 Impact factor: 3.279
Authors: Bernard Fisher; Stewart Anderson; John Bryant; Richard G Margolese; Melvin Deutsch; Edwin R Fisher; Jong-Hyeon Jeong; Norman Wolmark Journal: N Engl J Med Date: 2002-10-17 Impact factor: 91.245