Endocrine Therapy in Older Women with Early-Stage Hormone Sensitive Breast Cancer

Abstract

Breast cancer is the most common cancer affecting women worldwide, with the highest risk in those aged 70 and over. Most older women (80% to 85%) have hormone receptor positive breast cancer and thus the use of endocrine therapy is common in this population. Typically, women receive endocrine therapy for at least 5 years to reduce the risk of cancer recurrence and decrease breast-cancer mortality. However, adherence to hormonal therapy may be an issue, particularly in older women, as side effects may lead to early discontinuation and/or non-adherence. Older women on endocrine therapy are often cared for by primary care physicians and geriatricians and therefore, an understanding of oral endocrine therapy, as well as its potential side effects, is essential for treating physicians. This review describes the benefits of endocrine therapy in patients with resected breast cancer, compare different hormonal therapies with regards to side-effects and discuss management strategies with a particular focus on the concerns of older breast cancer patients on endocrine therapy. Mrs. Smith is a 75-year-old woman whose family doctor noted a 3 cm to 4 cm lump in her left breast during a routine physical exam. She has no palpable lymph nodes. Her family doctor sends her for a mammogram which reveals a 2.6 cm spiculated mass in the left upper outer quadrant. Biopsy reveals an invasive ductal carcinoma.