Top

Published in:

01-07-2008 | Review

Breast cancer in elderly women. Optimizing the treatment

Authors: Roberto Gennari, Riccardo A. Audisio

Published in: Breast Cancer Research and Treatment | Issue 2/2008

Abstract

The elderly population is on the rise. Breast cancer is the most common cancer in western women and its incidence increases with age. Despite the epidemiological burden of this condition, there is a lack of knowledge regarding the management of older patients, as treatment planning is mainly based on personal preferences rather than hard data. Older women are often offered sub-optimal treatment when compared to their younger counterpart at any particular stage. This is due to various reasons, including the lack of scientific evidence from well-conducted clinical trials. Reluctance to prescribe systemic treatments may be explained by the complexity of cost-benefit evaluations in such patients. It is also an ethical dilemma to decide how aggressive one should be when it comes to treat cancer in the elderly in view of the higher rate of cognitive impairment and specific patients’ expectations. This paper reviews the currently available evidence and attempts presenting and discussing chemoprevention of breast cancer, risk and benefit of hormone replacement therapy and the various treatment options for older women with breast cancer.

Kimmick GG, Balducci L (2000) Breast cancer and aging: clinical interactions. Hematol Oncol Clin North Am 14:213–234PubMedCrossRef

Ries LAG, Kosary CL, Hankey BF et al (1998) National cancer institute seer cancer statistics review 1973-1995 (specific data from NCHS Public Use Tape). National Cancer Institute, Bethesda, MD

Lash TL, Silliman RA (1998) Prevalence of cancer. J Natl Cancer Inst 90:399–400PubMedCrossRef

Parkin DM, Bray FI, Devesa SS (2001) Cancer burden in the year 2000. The global picture. Eur J Cancer 37:S4–S66PubMedCrossRef

Guralnik JM (1996) Assessing the impact of comorbidity in the older population. Ann Epidemiol 6:376–380PubMedCrossRef

Mandelblatt JS, Bierman AS, Gold K et al (2001) Constructs of burden of illness in older patients with breast cancer: comparison of measurement methods. Health Serv Res 36:1085–107PubMed

National Institutes of Health (1991) NIH Consensus Conference: treatment of early breast cancer. JAMA 265:391–395CrossRef

Nattinger AB, Gottlieb MS, Veum J et al (1992) Geographic variation in the use of breast-conserving treatment for breast cancer. N Engl J Med 326:1147–1149CrossRef

Cancer and Leukemia Group B (1999) Protocol no. 9343: Tamoxifen vs. radiotherapy and tamoxifen after breast conservation in the elderly with local disease. Cancer and Leukemia Group B, Chicago, IL

10.

Hughes K, Schnaper L, Berry D et al (2004) Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 351:971–977PubMedCrossRef

11.

Turner RR, Ollila DW, Krasne DL et al (1997) Histopathologic validation of the sentinel lymph node hypothesis for breast carcinoma. Ann Surg 226:271–276PubMedCrossRef

12.

Goldhirsch A, Glick JH, Gelber RD et al (2005). Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol 16:1569–1583PubMedCrossRef

13.

Ashing-Giwa K, Ganz PA, Petersen L (1999) Quality of life of African-American and white long term breast carcinoma survivors. Cancer 85:418–426PubMedCrossRef

14.

Eaker S, Dickman PW, Bergkvist L et al (2006) Differences in management in older women influence breast cancer survival: results from a population-based database in Sweden. PLoS 3:e25CrossRef

15.

Bouchardy C, Rapiti E, Fioretta G et al (2003) Undertreatment strongly decreases prognosis of breast cancer in elderly women. J Clin Oncol 21:3580–3587PubMedCrossRef

16.

Audisio RA, Bozzetti F, Gennari R et al (2004) The surgical management of senior cancer patients: opinions of the SIOG surgical task force. Eur J Cancer 40:926–938PubMedCrossRef

17.

Spencer G (1989) Projections of the population of the United States by age, sex and race 1988–2080. Washington DC. US Government Printing Office; Current Population Reports: series p 25 No.1018

18.

Sclare G (1991) Malignancy in nonagenarians. Scott Med J 36:12–15PubMed

19.

Stampfer MJ, Colditz GA (1991) Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiological evidence. Prev Med 20:47–63PubMedCrossRef

20.

Kiel DP, Felson DT, Andersen JJ et al (1987) Hip fracture and the use of estrogens in postmenopausal women. The framingham study. N Engl J Med 317:1169–1174PubMedCrossRef

21.

Tang M, Jacobs D, Stern Y et al (1996) Effect of oestrogen during menopause on risk and age at onset of Alzzheimer’s disease. Lancet 34:429–4328CrossRef

22.

Theriault RL (1996) Hormone replacement therapy and breast cancer: an overview. Br J Ob Gyn 103(13S):87–91

23.

Farquhar CM, Marjoribanks J, Lethaby A et al (2005) Long term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 20(3):CD004143

24.

Rossouw JE, Anderson GL, Prentice RL et al (2002) Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 288:321–333PubMedCrossRef

25.

Ravdin PM, Cronin KA, Howlader N et al (2007) The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 356:1670–1674PubMedCrossRef

26.

Fisher B, Costantino JP, Wickerham DL et al (1998) Tamoxifen for prevention of breast cancer: report of the national surgical adjuvant breast and bowel project p-1 study. J Natl Cancer Inst 90:1371–1388PubMedCrossRef

27.

Fisher B, Costantino JP, Wickerham DL et al ( 2005) Tamoxifen for the prevention of breast cancer: current status of the national surgical adjuvant breast and bowel project p-1 study. J Natl Cancer Inst 97:1652–1662PubMed

28.

Cuzick J, Forbes JF, Sestak I et al (2007) Long-term results of tamoxifen prophylaxis for breast cancer–96-month follow-up of the randomized IBIS-I trial. J Natl Cancer Inst 99:272–282PubMedCrossRef

29.

Vogel VG, Costantino JP, Wickerham DL et al (2006) Effects of tamoxifen vs raloxifen on the risk of developing breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 295:2727–2741PubMedCrossRef

30.

Dunn BK, Wickerham DL, Ford LG (2005) Prevention of hormone-related cancers: breast cancer. J Clin Oncol 23:4469–4470CrossRef

31.

Sweeney C, Blair CK, Anderson KE et al. (2004) Risk factors for breast cancer in elderly women. Amer J Epidemiol 160:868–875 CrossRef

32.

Diab SG, Elledge RM, Clark GM (2000) Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst 92:550–556PubMedCrossRef

33.

Gennari R, Curigliano G, Rotmensz N et al (2004) Breast carcinoma in elderly women. Features of disease presentation, choice of local and systemic treatments compared with younger postmenopausal patients. Cancer 101:302–310CrossRef

34.

Freyer G, Braud AC, Chaibi P et al (2006) Dealing with metastatic breast cancer in elderly women: results from a French study on a large cohort carried out bi the “Observatory on elderly patients”. Ann Oncol 17:211–216PubMedCrossRef

35.

Grann VR, Troxel AB, Zojwalla NJ et al (2005) Hormone receptor status and survival in a population-based cohort of patients with breast carcinomas. Cancer 103:2241–2251PubMedCrossRef

36.

Pierga JY, Girre V, Laurence V et al (2004) Characteristics and outcome of 1755 operable breast cancers in women over 70 years of age. Breast 13:369–375PubMedCrossRef

37.

Nixon AJ, Neuberg D, Hayes DF et al (1994) Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 12:888–894PubMed

38.

Molino A, Giovannini M, Auriemma A et al (2006) Pathological, biological and clinical characteristics, and surgical management of elderly women with breast cancer. Crit Rev Oncol Hematol 59:226–233PubMedCrossRef

39.

Daidone MG, Coradini D, Martelli G et al (2003) Primary breast cancer in elderly women: biological profile and relation with clinical outcome. Crit Rev Oncol Hematol 45:313–325PubMedCrossRef

40.

van Dijck JA, Holland R, Verbeek AL et al (1994) Efficacy of mammographic screening in the elderly: a case-referent study in the Nijmegen program in the Netherlands. J Natl Cancer Inst 86:934–938PubMedCrossRef

41.

McCarthy EP, Burns RB, Freund KM et al (2000) Mammography use, breast cancer stage at diagnosis, ad survival among older women. J Am Ger Soc 48:1226–1233

42.

Randolph WM, Goodwin JS, Mahnken JD et al (2002) Regular mammography use is associated with elimination of age-related disparities in size and stage of breast cancer diagnosis. Ann Int Med 137:783–790PubMed

43.

McPherson CP, Swenson KK, Lee MW (2002) The effects of mammographic detection and co-morbidity on the survival of older women with breast cancer. J Am Ger Soc 50:1061–1068CrossRef

44.

Pestalozzi BC, Luporsi-Gely E, Jost LM et al (2005) ESMO Minimum Clinical Recommendations for diagnosis, adjuvant treatment and follow-up of primary breast cancer. Ann Oncol 16(Suppl 1):i7–i9PubMedCrossRef

45.

Preece PE, Wood RA, Mackie CR (1982). Tamoxifen as initial sole treatment of localised breast cancer in elderly women: a pilot study. Br Med J 284:869–870CrossRef

46.

Audisio RA, Ramesh H, Longo WE et al (2005) Preoperative assessment of surgical risk in oncogeriatric patients. Oncologist 10:262–268PubMedCrossRef

47.

Pope D, Ramesh H, Gennari R et al (2007) Preoperative Assessment of Cancer in the Elderly (PACE): a comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery. Surg Oncol 15:189–197CrossRef

48.

Bland KI, Scott-Conner BE, Menck H et al (1999) Axillary dissection in breast conserving surgery for stage I and stage II breast cancer: a National Cancer Data Base Study of patterns of omission and implications for survival. J Amer Coll Surgeons 188:586–595CrossRef

49.

Kuehn T, Klauss W, Darsow M et al (2000) Long term morbidity following axillary surgery dissection in breast cancer patients—clinical assessment, significance for life quality and impact of demographic, oncologic and therapeutic factors. Breast Cancer Res Treat 64:275–282PubMedCrossRef

50.

Chetty U, Jack W, Prescott RJ et al (2002) Management of the axilla in operable breast cancer treated by breast conserving surgery: a randomized trial. Edinburgh Breast Unit. Br J Surg 87:163–169 CrossRef

51.

Hind D, Wyld L, Beverley CB et al (2006) Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus) (Review). Cochrane Database Syst Rev (1):CD004272

52.

Martelli G, Boracchi P, De Palo M et al (2005) A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: results after 5 years of follow-up. Ann Surg 242:1–6PubMedCrossRef

53.

Rudenstam CM, Zahrieh D, Forbes JF et al (2006) International Breast Cancer Study Group. Randomized trial comparing axillary clearance versus no axillary clearance in older patients with breast cancer: first results of International Breast Cancer Study Group Trial 10–93. J Clin Oncol 24:337–344PubMedCrossRef

54.

Veronesi U, Paganelli G, Viale G et al (2003) A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 349:546–553PubMedCrossRef

55.

Gennari R, Rotmensz N, Perego E et al (2004) Sentinel node biopsy in elderly breast cancer patients. Surg Oncol 13:193–196PubMedCrossRef

56.

Bowman CC, Lennox PA, Clugston PA et al (2006) Breast reconstruction in older women: should age be an exclusion criterion? Plast Reconstr Surg 118:16–22PubMedCrossRef

57.

Lipa JE, Youssef AA, Kuerer HM et al (2003) Breast reconstruction in older women: advantages of autogenous tissue. Plast Reconst Surg 111:1110–1121PubMedCrossRef

58.

Truong PT, Bernstein V, Lesperance M et al (2006) Radiotherapy omission after breast-conserving surgery is associated with reduced breast cancer-specific survival in elderly women with breast cancer. Am J Surg 191:749–755PubMedCrossRef

59.

Smith BD, Gross CP, Smith GL (2006) Effectiveness of radiation therapy for older women with early breast cancer. J Natl Cancer Inst 98:681–690PubMedCrossRef

60.

Manders K, van de Poll-Franse LV, Creemers GJ et al (2006) Clinical management of women with metastatic breast cancer: a descriptive study according to age group. BMC Cancer 6:179PubMedCrossRef

61.

Hershman DL, Wang X, McBride R et al (2006) Delay in initiating adjuvant radiotherapy following breast conservation surgery and its impact on survival to elderly patients. Int J Radiat Oncol Biol Phys 65:1353–1360 PubMed

62.

www.prime2.org

63.

Geiger AM, Thwin SS, Lash TL et al (2007) Recurrences and second primary breast cancers in older women with initial early-stage disease. Cancer 109:966–974PubMedCrossRef

64.

Smith BD, Haffty BG, Hurria A et al (2006). Postmastectomy radiation and survival older women with breast cancer. J Clin Oncol 24:4901–4907PubMedCrossRef

65.

DiFronzo LA, Tsai PI, Hwang JM et al (2005) Breast conserving surgery and accelerated partial breast irradiation using the MammoSite system: initial clinical experience. Arch Surg 140:787–794PubMedCrossRef

66.

Gennari R, Perego E, Ballardini B et al (2004) Surgical technique of Mammosite RTS implant for accelerated radiation delivery in breast conservative treatment. J Exp Clin Cancer Res 23:411–415PubMed

67.

Veronesi U, Orecchia R, Luini A et al (2005) Full-dose intraoperative radiotherapy with electrons during breast-conserving surgery: experience with 590 cases. Ann Surg 242:101–106PubMedCrossRef

68.

Orecchia R, Veronesi U (2005) Intraoperative electrons. Semin Radiat Oncol 15:76–83PubMedCrossRef

69.

Eifel P, Axelson JA, Costa J et al (2001) National Institute of Health Consensus Development Statement: adjuvant therapy for breast cancer, November 1–3, 2000. J Natl Cancer Inst 93:979–989PubMedCrossRef

70.

Early Breast Cancer Trialists’ Collaborative Group (2005) Effect of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of randomised trials. Lancet 365:1687–1717CrossRef

71.

Crivellari D, Price K, Gelber RD et al (2003) Adjuvant endocrine therapy compared with no systemic therapy for elderly women with early breast cancer. 21-Year results of International Breast Cancer Study Group Trial IV. J Clin Oncol 21:4517–4523PubMedCrossRef

72.

Thurlimann B, Keshaviah A, Coates AS et al (2005) A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. N Engl J Med 353:2747–2757PubMedCrossRef

73.

ATAC Trialists Group (2006) Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet 365:60–62

74.

The ATAC (Arimidex, Tamoxifen Alone or in Combination) Trialists’ group (2002) Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet 359:2131–2139 CrossRef

75.

The Breast International Group BIG 1–98 (2005) Randomized double blind phase III study to evaluate letrozole (L) vs tamoxifen (T) as adjuvant endocrine therapy for postmenopausal women with receptor positive breast cancer. N Engl J Med 353:2747–2757CrossRef

76.

A Muss (2001) Older age: not a barrier to cancer treatment. N Engl J Med 345:1128–1129CrossRef

77.

Mitka M (2003) Too few older patients in cancer trials. JAMA 290:27–28PubMedCrossRef

78.

Holmes CE, Muss HB (2003) Diagnosis and treatment of breast cancer in the elderly. CA Cancer J Clin 53:227–244PubMedCrossRef

79.

Lewis JH, Kilgore ML, Goldman DP et al (2003) Partecipation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol 21:1383–1389PubMedCrossRef

80.

Hutchins LF, Unger JM, Crowley JJ et al (1999) Underrepresentation of 65 years of age or older in cancer-treatment trials. N Engl J Med 30:2061–2067CrossRef

81.

Elkin EB, Hurria A, Mitra N et al (2006) Adjuvant chemotherapy and survival in older women with hormone receptor-negative breast cancer: assessing outcome in a population-based, observational cohort. J Clin Oncol 24:2757–2764PubMedCrossRef

82.

Giordano SH, Duan Z, Kuo YF et al (2006) Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol 24:2750–2756PubMedCrossRef

83.

Berry DA, Cirrincione C, Henderson IC et al (2006) Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA 295:1658–1667PubMedCrossRef

84.

Muss HB, Woolf S, Berry D et al (2005) Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA 293:1073–1081PubMedCrossRef

85.

Early Breast Cancer Trialists’ Collaborative Group (1998) Polychemotherapy for early breast cancer: an overview of randomised trial. Lancet 352:930–942CrossRef

86.

Crivellari D, Bonetti M, Castiglione Geertsch M et al (2000) Burdens and benefit of adjuvant cyclophosphamide, methotrexate, and fluorouracil and tamoxifen for elderly patients with breast cancer: the International Breast Cancer Study Group Trial VII. J Clin Oncol 18:1412–1422PubMed

87.

Gelman RS, Taylor SG 4th (1984) Cyclophosphamide, methotrexate and 5-fluorouracil chemiotherapy in women more than 65 years old with advanced breast cancer: the elimination of age trands in toxicity by using doses based on creatinine clearance. J Clin Oncol 2:1404–1413

88.

Wils JA, Bliss JM, Marty M et al (1999) Epirubicin plus tamoxifen versus tamoxifen alone in node positive postmenopausal patients with breast cancer: a randomized trial of the international collaborative cancer group. J Clin Oncol 17:1988–1999PubMed

89.

Ibrahim NK, Frye DK, Buzdar AU (1996) Doxorubicin-based chemotherapy in elderly patients with metastatic breast cancer. Tolerance and outcome. Arch Intern Med 156:882–888PubMedCrossRef

90.

Constenla M, Lorenzo I, Carrete N et al (2000) Docetaxel (TXT) monotherapy & G-CSF for advanced breast cancer (ABC) in elderly patients (EP). Proc Am Soc Clin Oncol 19:425

91.

Smith I, Procter M, Gelber RD et al (2007) 2-Year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: a randomised controlled trial. Lancet 369:29–36PubMedCrossRef

92.

Romond EH, Perez EA, Bryant et al (2005) Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. New Engl J Med 353:1673–1684

93.

http://www.adjuvantonline.com

94.

Burdette-Radoux S, Muss HB (2006) Adjuvant chemotherapy in the elderly: whom to treat, what regimen? Oncologist 11:234–242PubMedCrossRef

95.

Ramia JM, Villar J, Villegas T et al (2005) Surgical treatment of liver metastases from breast cancer. Cir Esp 78:318–322PubMedCrossRef

96.

d’Annibale M, Piovanello P, Cerasoli V et al (2005) Liver metastases from breast cancer: the role of surgical treatment. Hepatogastroenterology 52:1858–1862PubMed

97.

Rapiti E, Verkooijen HM, Vlastos G et al (2006) Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis. J Clin Oncol 24:2743–2749PubMedCrossRef

98.

Ellis MJ, Coop A, Singh B et al (2001) Letrozole is more effective neoadjuvant endocrine therapy than tamoxifen for ErbB-1- and/or ErbB-2-positive, estrogen receptor-positive primary breast cancer: evidence from a phase III randomized trial. J Clin Oncol 19:3808–3816PubMed

99.

Joensuu H, Ejlertaen B, Lonning PE (2005) Aromatase inhibitors in the treatment of early and advanced breast cancer. Acta Oncol 44:23–31PubMedCrossRef

100.

Howell A, Robertson JFR, Quaresma AJ et al (2002) Fulvestran, formerly ICI 182780, is as effective as anastrozole in postmenopausal women with advanced breast cancer progressing after prior endocrine treatment. J Clin Oncol 20:2296–3403CrossRef

101.

Botteman M, Barghout V, Stephens J et al (2006) Cost effectiveness of biphosphonates in the management of breast cancer patients with bone metastases. Ann Oncol 17:1072–1082PubMedCrossRef

102.

Miles D, Von Minckwitz G, Seiderman A (2002) Combination versus sequential single-agent therapy in metastatic breast cancer. Oncologist 7:13–19PubMed

103.

Jones SE, Erban J, Overmoyer B et al (2005) Randomized phase III study of docetaxel compared with paclitaxel in metastatic breast cancer. J Clin Oncol 23:5542–5551PubMedCrossRef

104.

Del Mastro L, Perrone F, Repetto L et al (2005) Weekly paclitaxel as first-line chemotherapy in elderly advanced breast cancer patients: a phase II study of the Gruppo Italiano di Oncologia Geriatrica (GIOGer). Ann Oncol 16:253–258PubMedCrossRef

105.

Feher O, Vodvarka P, Jessem J et al (2005) First-line gemcitabine versus epirubicin in postmenopausal women aged 60 or older with metastatic breast cancer: a multicentric, randomised, phase III study. Ann Oncol 16:899–908PubMedCrossRef

106.

Bajetta E, Procopio G, Celio L et al (2005) Safety and efficacy of two different doses of capecitabine in the treatment of advanced breast cancer in older women. J Clin Oncol 23:1–7CrossRef

107.

Crivellari D, Lombardi D, Corona G et al (2006) Innovative schedule of oral idarubicin in elderly patients with metastatic breast cancer: comprehensive results of phase II multi-istitutional study with pharmacokinetic drug monitoring. Ann Oncol 17:807–812PubMedCrossRef

108.

Hess D, Thurlimann B, Pagani O et al (2004) Capecitabine and vinorelbine in edeely patients (>or=65 years) with metastatic breast cancer. A phase I trial (SAKK 25/99). Ann Oncol 15:1760–1765PubMedCrossRef

109.

Crivellari D, Price K, Gelber RD et al (2003) Adjuvant endocrine therapy compared with no systemic therapy for elderly women with early breast cancer: 21-year results of International Breast Cancer Study Group Trial IV. J Clin Oncol 21:4517–4523PubMedCrossRef

110.

Fisher CJ, Egan MK, Smith P et al (1997) Histopathology of breast cancer in relation to age. Br J Cancer 75:593–596PubMed

111.

Coates AS (1999) Breast cancer: delays, dilemmas, and delusions. Lancet 353:1112–1113PubMedCrossRef

112.

Bergman L, Kluck HM, van Leeuwen FE et al (1992) The influence of age o treatment choice and survival of elderly breast cancer patients in south-eastern Netherlands: a population-based study. Eur J Cancer 28A:1475–1480PubMedCrossRef

113.

de Rijke JM, Schouten LJ, Schouten HC et al (1996) Age-specific differences in the diagnostics and treatment of cancer aged 50 years and older in the province of Limburg, The Netherlands. Ann Oncol 7:677–685PubMed

114.

Yancik R, Ries LA (2000). Aging and cancer in America: demographic and epidemiologic perspectives. Hematol Oncol Clin North Am 14:17–23PubMedCrossRef

115.

Biganzoli L, Aapro M, Balducci L et al (2004) Adjuvant therapy in elderly patients with breast cancer. Clin Breast Cancer 5:188–195PubMedCrossRef

116.

Coebergh JWW (1996) Significant trends in cancer in the elderly. Eur J Cancer 32A:569–571PubMedCrossRef

117.

Lipschitz DA, Goldstein S, Weksler ME et al (1985) Cancer in the elderly: basic science and clinical aspects. Ann Intern Med 102:218–228PubMed

118.

Balducci L, Beghe C (2001). Cancer and age in USA. Crit Rev Oncol Hematol 37:137–145PubMedCrossRef

119.

Rao VS, Garimella V, Hwang M et al (2007) Management of early breast cancer in the elderly. Int J Can 120:1155–1160CrossRef

120.

Passage KJ, McCarthy NJ (2007) Critical review of the management of early-stage breast cancer in elderly women. Intern Med J 37:181–189PubMedCrossRef

121.

Tejeda HA, Green SB, Trimble EL et al (1996) Representation of African-Americans, Hispanics, and withes in National Cancer Institute cancer treatment trials. J Natl Cancer Inst 88:812–816PubMedCrossRef

122.

Fentiman IS, Tirelli U, Monfardini S et al (1990) Cancer in the elderly: why so badly treated? Lancet 335:1020–1022PubMedCrossRef

Title: Breast cancer in elderly women. Optimizing the treatment
Authors: Roberto Gennari
Riccardo A. Audisio
Publication date: 01-07-2008
Publisher: Springer US
Published in: Breast Cancer Research and Treatment / Issue 2/2008
Print ISSN: 0167-6806
Electronic ISSN: 1573-7217
DOI: https://doi.org/10.1007/s10549-007-9723-4

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2008

Genetic polymorphisms in uridine diphospho-glucuronosyltransferase 1A1 and breast cancer risk in Africans

Antibodies to 46-kDa retinal antigen in a patient with breast carcinoma and cancer-associated retinopathy

CASP8 polymorphisms, estrogen and progesterone receptor status, and breast cancer risk

The prognostic value of Stathmin-1, S100A2, and SYK proteins in ER-positive primary breast cancer patients treated with adjuvant tamoxifen monotherapy: an immunohistochemical study

Consensus genes of the literature to predict breast cancer recurrence

Distribution and significance of caveolin 2 expression in normal breast and invasive breast cancer: an immunofluorescence and immunohistochemical analysis

Keynote webinar | Spotlight on antibody–drug conjugates in cancer