Change of paradigm in treating elderly with breast cancer: are we undertreating elderly patients?

Developed countries face significant population ageing in the near future. Within 20 years, the average age will approach 50 years and the largest population cohort will be those over 65 years. The incidence of breast cancer increases with age, with a risk in women of 0.44% by the age of 30, 3.82% by the age of 70 and 10% by the age of 80. Breast cancer is responsible for one out of every three cancer-related deaths. Elderly patients have higher mortality rates and most breast cancer-related deaths are observed in women over 65. There appears to be a trend that elderly patients with breast cancer receive less than the standard treatment compared to younger counterparts and this leads to poorer outcomes. The rationale for treating elderly breast cancer patients more conservatively is that breast cancers in this cohort are more commonly oestrogen receptor (ER) positive which gives the clinician the option to treat with hormonal manipulation alone. In addition, elderly patients present at a later stage compared to younger patients who frequently present with early (stages I and II) breast cancer. This review aims to give an overview of the diagnosis, treatment options and surveillance of breast cancer in elderly women (over 75 years) and to discuss the change in perception of the term 'elderly' and the reasons for undertreatment in the elderly patients.