Biology, not chronology, driven treatment of breast cancer in the elderly

Abstract

Breast cancer is the most common cancer site in women, with 1.15 million new cases worldwide each year, of which 361,000 (27.3% of all cancers in females) are in Europe and 230,000 (31.3%) in Northern America. This means that half, if not more, of these patients are in other parts of the world, a fact recognised by the World Health Organization (WHO), which has put cancer among its health priorities on a global scale. In 2002, 411,000 women died of breast cancer worldwide, and most of these were aged 65 years or older. This is explained by the following figures. The crude incidence of breast cancer in Northern America in comparison with North and Western Europe is 141.9 and 130.0 per 100,000 females per year, respectively. Breastcancer-related mortality is 29.8 and 41.0 per 100,000 females, respectively. For those aged 65 years and older, crude incidence rates are 432.7 per 100,000 females in Northern America and 295.0 per 100,000 in Northern and Western Europe; corresponding breast cancer mortality figures are 121.2 and 135.0 per 100,000 females, respectively. Similar incidence rates and mortality figures are found in South America (Argentina and Uruguay), New Zealand and Australia, and in Central/Eastern Europe. With increasing age, patients will suffer from ailments related both to senescence and to cancer. Many will need the expertise of the geriatrician and of the oncologist, who will participate in specific case discussions to look at social and medical issues that will affect the treatment plan (with surgery, radiation and drug therapy, rehabilitation and supportive and palliative care questions often intertwined). The wishes of the patient are key in this discussion. 1 The variable reality of family or community support must also be taken into consideration, as this differs so widely among cultures; the ways in which these cultures are changing are also important, especially as the modern world moves very fast – faster than most elderly (and not so elderly) people can apprehend. 2