breast cancer in the elderly
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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]
- most older women do not experience cancer-related cognitive decline within the 1st 2 years after diagnosis & treatment[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
- alopecia
- scalp cooling system (DigniCap) FDA-approved Dec 2015 may reduce chemotherapy (taxane)-related alopecia
- cognitive impairment
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
More general terms
References
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/18098268
- ↑ 2.0 2.1 2.2 2.3 Medical Knowledge Self Assessment Program (MKSAP) 11, 14, 15, 18. American College of Physicians, Philadelphia 1998, 2006, 2009, 2018.
- ↑ 3.0 3.1 Prescriber's Letter 11(4):22 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200408&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 4.0 4.1 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: https://www.ncbi.nlm.nih.gov/pubmed/20625130
- ↑ 5.0 5.1 5.2 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
- ↑ Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
- ↑ 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