International Journal of Breast Cancer chemotherapy either with a single agent or multiple agents. About 55% of patients in the 70–74 years age group received chemotherapy as opposed to only 35% in those 80 years old and greater. However, this diﬀerence was not signiﬁcant (P < 1). There were 113 patients with positive margins of resection. Of those, 87% received radiation therapy. However, there was a signiﬁcant diﬀerence in the number of patients who received radiation therapy in the 70–74 compared to that in the ≥80 age group (P ≤ 0.025). In patients with hormone receptor positive status, 84% received hormone therapy in the 70–74 age group and about 90% in the ≥80 age group. 4. Discussion Previous studies have suggested that age was the strongest predictor of lesser treatment [3, 4] and that was what we sought to validate in the study. Our data have shown that there are observable diﬀerences in the diﬀerent parameters measured among the subgroups and that there was a trend for the older cohort to be undertreated compared to the younger cohorts, but most of these observations were not deemed statistically signiﬁcant. A notable diﬀerence was that of survival after ﬁve years of diagnosis. Signiﬁcant diﬀerences were noted between the 80 and older age group and the 70–74 and 75–79 age groups. However, whether or not age alone in this case is the strongest predictor for survival cannot be fully determined. But besides age, perhaps the ﬁndings also imply that survival is impacted by other parameters besides the tumor and patient characteristics identiﬁed in the study and that perhaps functional status and comorbidities play a role. Previous studies in other cancer researches have shown that central to the decision making in the elderly is the concept of life expectancy [15, 16]. It is true that breast cancer increases with age. At the same time, as the age increases, the risk of death from causes besides breast cancer also increases [17]. Then, there is variability within an age cohort, with frail 70 year olds and robust 80 year olds. It is, therefore, signiﬁcant to consider the patient’s functional status and comorbidities in determining maximum treatment beneﬁts for patients. It has been shown, for example, in cancer patients that poor functional status correlates with worse outcomes regardless of the type of cancer [18]. In weighing the beneﬁts and risks of treatment therefore, breast cancer-speciﬁc prognosis, nonbreast-cancer-speciﬁc prognosis, and treatment-related toxicities should be accounted for. The National Comprehen- sive Cancer Network [19] has recommended the inclusion of the use of a geriatric assessment tool in developing care plans for the elderly cancer patient. Whether the assumption therefore, that perhaps functional status and comorbidities have contributed largely to the diﬀerence in survival cannot be determined as information was not available in the tumor registry. Surgery is still the mainstay of treatment for patients with early stage cancer. It has been shown that breast conservation surgery which involves lumpectomy with or without subse- quent axillary dissection, followed by irradiation, has equal 5 eﬃcacy to more extensive surgical options such as mastec- tomy. However, current data suggests that elderly women are less likely to be oﬀered breast conservation surgery than their younger counterparts (25% versus 42%) [20, 21]. Our study has shown that in this institution, mastectomy and lumpectomy were performed at almost the same frequency although adjuvant therapy was omitted in most cases. Staging was done for majority of patients (71%). There was no diﬀerence between age groups (P < 0.20) although younger patients were staged more than the 80 years and older cohort. Again, whether this was because of age alone cannot be determined. Still regardless of age, inﬁltrating ductal carcinoma is the most common histologic subtype as demonstrated in our study as well. Older patients have also been noted to have a greater frequency of tumors with more indolent histologies and overall more favorable biologic tumor proﬁle. Older women are likely to express estrogen and progesterone receptors, which improves prognosis. This also makes them candidates for adjuvant hormonal therapy [22, 23]. In our study, majority of the patients with positive hormone receptor status received hormonal therapy. As suggested by prior studies, treatments that oﬀer less toxicity are oﬀered to patients with advanced age. Hormonal therapy which carries less risks and toxicity compared to chemotherapy is more likely to be oﬀered and given to elderly patients with breast cancer. With regard to chemotherapy, cytotoxic drugs most commonly used in this setting like cyclophosphamide, methotrexate, and 5-ﬂuorouracil represent the second line of systemic therapeutic agents available for women with breast cancer. There is paucity of data when it comes to women over the age of 70. In the Early Breast Cancer Trials Collaborative Group, it was shown that chemotherapy did not oﬀer any advantage in survival for women over the age of 70 [24]. However, part of the limitation of this study was that there were very few cohorts over age 75 and that dosing was much less compared to the younger patient cohorts. Our study have shown that chemotherapy was not generally oﬀered to our study cohort and although there was no statistical diﬀerence, there was note of a trend to give less chemotherapy as the patient gets older (see Table 3). This may stem from issues of toxicity of these agents and also by suggestions of less advantage as presented in previous trials. Radiation therapy is well tolerated in the elderly. It decreases ipsilateral breast cancer recurrence after breast conservation surgery and chest wall recurrence after a mastectomy. Our study showed that in patients 80 years and older, radiation therapy was given less than that in the 70–74 year old cohort (see Table 1), which is reasonable given numerous data that merely show a decrease in local recurrence but ultimately had no eﬀect on survival [25, 26]. A previous study by Fyles et al. [27] showed that despite reduced risk of local (7.7 to 0.6% P < 0.001) and axillary (2.5 to 0.5% P < 0.49) recurrence, there was no signiﬁcant diﬀerence in survival. The study of Ragaz et al. [28] demonstrated the same trend of decrease in locoregional recurrence but no advantage in decreasing distant metastasis or improving survival. It may be reasonable, therefore, to