Adjuvant therapy in breast cancer. Optimal use in the elderly.

Breast conservation surgery may replace mastectomy in patients with small, localised breast tumours of up to 4 cm in diameter. Clear surgical margins (microscopically defined) are desirable. Radiotherapy to the conserved breast is recommended for all patients, although it may be relatively safe to withhold it in some better-risk T1 patients. This decision must frequently be taken in the elderly and infirm. Adjuvant tamoxifen has an established place in the systemic management of all elderly patients with invasive breast cancer. In contrast, adjuvant chemotherapy has no established role in the elderly.