Treating Breast Cancer in Older Adults

Several forms of breast cancer are more likely to develop as people age. However, improvements in diagnosis and highly customized treatment regimens are raising the likelihood of recovery for elderly women and enabling many to lead longer, healthier lives despite developing breast cancer. There are several treatment choices for older adults with breast cancer that have positive outcomes, depending on the patient’s health and personal preferences.

What are the common types of breast cancer diagnosed in older patients?

Invasive ductal carcinoma, also known as IDC, and invasive lobular carcinoma, also known as ILC, are the two types of breast cancers in women most frequently diagnosed in this age group. Although they develop in different breast tissues, these tumors are treated similarly.

Hormone receptor positive tumors make up the majority of invasive malignancies in this age range. Breast cancers in elderly patients that are hormone-positive tend to grow slowly, which is hopeful news for patients and can mean a good prognosis and successful breast cancer management.

How does a patient’s age impact treatment decisions?

There is no reason to put off treating breast cancer in an older adult if she is otherwise healthy.

A patient’s treatment options become more challenging if she is ill, particularly if she has a condition like dementia or Parkinson’s disease. While these factors make treatment more complicated,  oncologists can still treat patients to increase comfort, even in these circumstances.

A patient’s functional age should be taken into account more so than their chronological age when making decisions about breast cancer treatment and breast cancer care. The functional age factors in the patient’s physical limits, comorbidities, and social support. For patients with breast cancer who are older but physically strong and otherwise healthy, all treatment options available to younger patients should be considered, including surgery if the patient has operable breast cancer. Chemotherapy, trastuzumab, and radiotherapy should be provided as routine adjuvant therapy to women with breast cancer who are older than 65 and whose life expectancy is greater than five years, and who are otherwise in good health. In patients who are frail, adjuvant therapies might be scaled back or abandoned. Enrollment in clinical trials should also be available to patients over the age of 65.

More FAQ’s about Treating Breast Cancer in Older Adults

What breast cancer treatment is most effective for elderly patients?

Doctors consider the features of the tumor when determining which treatment plan could be appropriate for a certain patient. This can help distinguish between tumors that may respond to other forms of treatment and those that are likely to respond to hormone-blocking therapy alone.

Mapping the genome of cancer cells through genomic breast cancer testing (also known as Oncotype tests) can help determine whether or not they will respond to hormone-blocking therapy, chemotherapy, or both. While Oncotype tests are not recommended for all patients, some with invasive tumors larger than 0.5 cm and estrogen-positive, the tests can reveal whether a particular breast cancer recurrence is likely following treatment.

Genetic testing for breast cancer in the elderly can now provide information on more advanced breast tumors, including those that have invaded the lymph nodes. With the aid of these findings, your doctor is better equipped than ever to suggest a treatment strategy for controlling breast cancer.

Do larger breast cancer tumors necessitate a mastectomy in every case?

A mastectomy is not necessary for all large tumors. The size of the tumor in relation to the size of the breast influences whether a lumpectomy or mastectomy should be performed during breast cancer surgery. If the patient had very large breasts, a 2-centimeter tumor would likely be manageable with a lumpectomy; nevertheless, if the patient had small breasts, a mastectomy would likely be advised.

Do older adults need to get a mastectomy if they have invasive breast cancer?

Mastectomy is one form of treatment for invasive breast cancer, but it isn’t always necessary, especially with all of the treatment options available today. The treatments your doctor prescribes, as well as their administration in what order, rely on a number of variables.

The patient and doctor together could decide the best course of action is to undergo chemotherapy first and then have a lumpectomy rather than a full mastectomy following chemotherapy if the tumor is small enough to do so.

New developments in breast-conserving surgery (lumpectomy) and mastectomy with reconstruction, such as oncoplastic breast reduction, nipple-sparing mastectomy, aesthetic flap closure, and other methods, can provide alternatives that preserve your appearance and self-image if surgery is the best option for you. Dr. Gorman always strives for breast-conserving surgery whenever possible.

Do older adults that have breast cancer need chemotherapy?

Although a chemotherapy regimen can be difficult, chemotherapy can be an effective strategy to shrink a tumor. However, chemotherapy may not always be required, depending on the patient’s particular circumstances.

The information obtained from the Oncotype genetic profile of cancer can help determine whether chemotherapy will be helpful in postmenopausal patients with invasive cancer whose tumor is larger than 1 centimeter and hormone receptor positive. Adjuvant chemotherapy may be associated with improved survival outcomes in elderly patients with breast cancer.

Even if elderly breast cancer patients have cancer in their lymph nodes, depending on the results of the tests, they may be able to forego chemotherapy in favor of hormone-blocking medication, which is easier to take and has fewer adverse effects. Hormone therapy can be given orally and spread out over five years.

Do all lymph nodes have to be removed if breast cancer has spread to them?

Not all the time. Fewer surgeries to remove axillary lymph nodes are currently being performed by surgeons. The risk of lymphedema was higher a few years ago when the recommendations were different, and breast cancer that had spread to the lymph nodes required the removal of every one of them.

Adjuvant radiation therapy to the residual lymph nodes has been shown in recent studies to be as effective as axillary lymph node removal at controlling local cancer in some patients with cancer in the lymph nodes.

Another method of avoiding axillary lymph node dissection is first to use chemotherapy to reduce the cancer’s size. Fewer lymph nodes may need to be removed if there is a positive response.

How common is triple negative breast cancer in older patients?

Triple negative breast cancer affects about 10% of older women with breast cancer. It is more common for elderly women to be diagnosed with a hormone receptor positive breast tumor.

What is the prognosis for invasive breast cancer in women aged 70 and up?

Although receiving a cancer diagnosis is frightening at any age, older people may feel more vulnerable. But there are reasons not to worry because, thanks to breast cancer research, treatment options have advanced greatly, especially with an early breast cancer diagnosis.

Most frequently, in individuals aged 70 or older, the invasive cancer is hormone receptor positive, indicating a slower-growing cancer and is diagnosed while it is still an early stage breast cancer.

The data shows that the majority of people who are treated for invasive breast cancer survive. Even if you are diagnosed later in life, you can still successfully complete your treatment, carry on with your life, and eventually pass away from causes unrelated to breast cancer. This is especially true for those who are capable of taking care of themselves and are in good overall health without another comorbidity at the time of their diagnosis.

Dr. Gorman is dedicated to offering patients of any age an advanced, personalized, and targeted approach to breast surgery and the treatment of breast cancer. Early detection is crucial when it comes to treatment options for breast cancer. Consult your doctor to discuss your symptoms and determine whether you require additional evaluation if you are concerned about any new changes in your breasts or possible breast cancer symptoms. To schedule a consultation with Dr. Gorman or to learn more information about breast cancer treatment, visit the Texas Breast Center website or call the office today.

Read the article on Age as an Influencer on the Risk of Breast Cancer