Optimal treatment of breast cancer in an elderly patient

Lawrence J. Solin, MD, FACR
Last Modified: August 11, 2002

Dear OncoLink "Ask The Experts,"
My mother was diagnosed with ductal carcinoma at the age of 85. A lumpectomy was performed and lymph nodes were clear. Radiation therapy has been recommended. We are trying to weigh the pros and cons to help her decide if radiation therapy is really necessary or appropriate at her age. Considering her age, can you offer any data or insight into the treatment of elderly breast cancer patients, which we could consider to help her reach a treatment decision?

Lawrence J. Solin, MD, FACR, Professor of Radiation Oncology at the University of Pennsylvania, responds:

Determining the optimal treatment of breast cancer in an elderly patient can be a difficult decision. Treatment decisions must be carefully considered for the elderly patient, and different treatments may be appropriate for different patients. Consultation with a radiation oncologist and a medical oncologist should be obtained so that the careful consideration for individualized treatment can be pursued for the specific patient in question. Elderly patients may benefit from the addition of radiation to reduce the risk of local recurrence, especially when there are no life-threatening medical conditions. The elderly patient without life-threatening medical conditions can have a surprisingly long life expectancy. Lumpectomy alone (or with tamoxifen) may be an appropriate choice for selected elderly patients, particularly those with short life expectancies. However, omission of radiation is associated with an increased risk of local recurrence, even for elderly patients. If the patient should have a local recurrence, this would occur at an even older age when treatment of local recurrence could be even more difficult. In short, no single answer is right for all elderly patients.