Abstract BL-2: Brinker Award Lecture: Older Women and Breast Cancer: Challenges and Opportunities
Authors: HB Muss
Journal: Cancer Research (2012)

Abstract In the United States and other developed nations breast cancer incidence and mortality rates rise dramatically with increasing age. This fact, coupled with the aging of the U.S population is leading to a tsunami of older women with breast cancer. Most oncologists lack training in geriatrics and the frequent comorbidities in older patients along with a new diagnosis of breast cancer makes treatment selection challenging. Little data from clinical trials are available to guide physicians in treatment selection and a paucity of geriatricians makes it difficult to develop comprehensive treatment plans for many older patients. Newer tools that are validated, fast, and user-friendly are now available to help busy clinicians do meaningful geriatric assessments which are necessary for evaluating the medical, functional, cognitive, psychological, and social status of older patients. Such tools can be used to accurately estimate survival in older patients and more recently to predict chemotherapy related toxicity. For older patients, maintenance of independent living and cognitive function are their major goals and such preferences must be taken into consideration when planning treatment. Older women, like younger women, are interested in body image and when possible should be offered breast preservation with lumpectomy and radiation. In some older women treated with lumpectomy and adjuvant endocrine therapy for small tumors that are hormone-receptor positive and lower grade, breast radiation may be omitted with only a small increase in the risk of in-breast recurrence. The majority of older patients with early stage breast cancer have hormone receptor positive, HER-2 negative breast cancers and are excellent candidates for endocrine therapy. The major issue in these patients is defining the potential added value of chemotherapy. Elders with HER-2 positive tumors may be good candidates for chemotherapy and trastuzumab, while for many with “triple-negative” lesions, chemotherapy is the option of choice. Older patients with metastatic breast cancer whose tumors have progressed after endocrine therapy can be considered for palliative chemotherapy and many single agent regimens are well tolerated in this setting. In these patients, making sure they are offered “structured” palliative care as part of their treatment program is integral to maximizing quality of life and possibly even prolonging survival. Lastly, eligible elders should be offered clinical trials participation. Although getting elders on trials remains a challenge, it's essential we work diligently on recruitment so as to obtain meaningful data on outcomes and toxicities of newer treatment regimens. Opportunities for trials of all types abound, not only for testing new treatments, but for defining interventions that minimize toxicity and loss of function. All of us in oncology will need to learn how to care for older cancer patients to provide them with optimal treatment. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr BL-2.