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breast cancer in the elderly

Pathology: - compared with younger women, elderly have less aggressive tumors Complications: - complications of therapy - cognitive impairment - most older women do not experience cancer-related cognitive decline within the 1st 2 years after diagnosis & treatment [5] - women with an apoE4 allele may be at high risk for cognitive decline [5] - increased risk of myelodysplasia, acute myeloid leukemia. endometrial cancer & (rarely) soft tissue sarcoma [2] - long-term aromatase inhibitor therapy increases risk of osteoporosis & pathologic fractures [2] - 30-50% of all long-bone pathologic fractures - most commonly occurs in proximal femur - alopecia - scalp cooling system (DigniCap) FDA-approved Dec 2015 may reduce chemotherapy (taxane)-related alopecia Management: - comorbidities & diminished life expectancy favor less aggressive therapy - breast-conserving surgery with adjuvant tamoxifen - option for elderly women with estrogen-receptor positive breast cancer - 15 year mortality: - 13% from breast cancer - 76% from all-causes - 24% disease-free after 15 years - adjuvant aromatase inhibitor may be better than tamoxifen [2,3,4] - when asked for advice on management of elderly woman with breast cancer (hormone sensitive or not), consider comprehensive geriatric assessment to: - estimate life expectancy independent of the cancer - assess functional status, comorbidities, falls, mood, cognition, & nutrition & their impact on benefits & harms related to cancer treatments

General

breast cancer cancer in the elderly

References

  1. Martelli G et al, Elderly breast cancer patients treated by conservative surgery alone plus adjuvant tamoxifen: Fifteen year results of a prospective study. Cancer 2008, 112:481 PMID: 18098268
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2018.
  3. Prescriber's Letter 11(4):22 2004 Detail-Document#: 200408 (subscription needed) http://www.prescribersletter.com
  4. Burstein HJ et al. American Society of Clinical Oncology clinical practice guideline: Update on adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. J Clin Oncol 2010 Jul 12 PMID: 20625130
  5. Kuznar W with expert critique by Gnanajothy R No Cognitive Decline in Most Older Women With Breast Cancer. Problem found mostly in those who are ApoE ?4-positive. MedPage Today. ASCO Reading Room 01.15.2019 https://www.medpagetoday.com/reading-room/asco/breast-cancer/77427
  6. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  7. Dotinga R Clinical Challenges: Treating Breast Cancer in the 'Very Old'. Aggressive treatment may still be an option. MedPage Today January 9, 2023. https://www.medpagetoday.com/clinical-challenges/sabcs-breast-cancer/102555