If you, or your loved one, are concerned about a diagnosis of breast cancer late in life, you should be aware of the following:
- Breast cancer incidence does increase with age.
- Many older patients who have breast cancer are not symptomatic from their breast cancer.
- Most elderly patients who have breast cancer die from diseases other than breast cancer.
- Many breast cancers in elderly patients respond to hormone-blocking agents.
- Not all elderly patients are the same.
The guiding principle physicians follow when treating all patients, but especially the elderly, is First, do no harm. Therefore, a patient who has a breast mass late in life should initially be offered a core needle biopsy, which will prevent a surgery for diagnosis.
When a cancer has been diagnosed in an elderly patient, it is very helpful to include the input of the family physician or internist, who can provide guidance as to which treatments for the cancer are appropriate and which treatments could bring more risk than benefit.
For patients whose cancers are sensitive to hormones, a hormone-blocking agent can be given as the first line of treatment (neoadjuvant hormone therapy). This approach is especially helpful for patients who have serious chronic conditions, such as renal failure, congestive heart failure, or COPD, which may increase the risk of anesthesia and surgery.
For older patients who are in excellent physical health, surgery may be the first therapy for their breast cancer. Surgery may also be recommended for patients whose breast cancers will not respond to hormone-blocking medications. Surgery of the breast is considered a lower risk surgery.
Patients 70 years and older who have an early-stage hormone-sensitive breast cancer removed by surgery may be able to avoid radiation therapy. The consulting radiation oncologist will work with the patient to make that decision. Of course, the patient’s wishes and circumstances are the primary considerations in this decision making process.
Chemotherapy is avoided in most elderly patients, especially in those who have other serious medical conditions and in those who are frail. Chemotherapy may be recommended in some very special circumstances, again depending on the patient’s preference and health, as well as the cancer’s biology and stage.
The Importance of Family History
A patient’s family history is also strongly considered. It is helpful if the matriarchs and patriarchs of the family can provide details about their family tree, which can assist in the detection of genetic defects that predispose one to cancers.
Oftentimes elderly patients are tested for genes known to increase breast cancer risk, not for directing their own personal treatments but rather for the benefit of their family members. Elderly patients who have a worrisome family history of breast cancer but whose current genetic testing does not reveal a genetic defect may choose to have their blood preserved to allow testing in the future when further discoveries in the field of genetics are made. Members of the breast cancer team can advise and assist you in these matters.
The Need to Plan for the Future
The diagnosis of cancer in an elderly patient provides an opportunity for discussion of a person’s plans for their twilight years. Families can more easily explore their family member’s current living situation, as well as end-of-life plans, during this time. Having these conversations is often difficult, but physicians and other healthcare professionals can provide information about local resources to assist patients and their families.