A woman can get breast cancer at any age. And statistically, a woman's risk of being diagnosed actually increases with age. This is why the figure is quoted that "1 in 8" women are diagnosed with breast cancer at some point their lives. What this number really means, however, is that as a woman nears her 80s, her risk is 1 in 8. The average age of diagnosis of breast cancer is in the mid-50s.
Treatment decisions for an elderly woman must always be considered within the context of what is appropriate, rational, and beneficial to her.
In some cases, no treatment is the best treatment. I realize that not treating breast cancer may seem like a bad decision for a family, or bad medicine on the part of the elderly woman's health care team. But we have to weigh the effectiveness of daily radiation, a course of chemotherapy, a mastectomy, possible reconstructive surgery, and other types of treatment for an elderly woman who, for example, lives in a nursing home, has Alzheimer's disease, diabetes, and congestive heart failure, and is on 12 different prescription medicines.
The breast cancer treatments listed above would affect the quality of life of even the healthiest younger woman. So the question the family of an elderly woman must ask is this: Given my mom's age and other medical conditions, will this treatment prolong her life enough to make living with the harsh side effects worth her while?
So, assessing Mom's medical condition and medical needs is very important in considering her projected longevity and how breast cancer may or may not be a contributing cause to her ill health and eventual death. This is not a decision a family should make separately from the health care team.
In the case of the elderly woman above, if she has only a small breast cancer among her many other medical conditions—some of which are far more serious—it's reasonable for the health care team to recommend minimal treatment, such as just giving her hormonal therapy.
Radiation is not used very often for elderly patients since its purpose is to prevent the local recurrence of this disease over time. If the health care team believes that Mom will succumb to congestive heart disease, lung disease, or some other mixture of disorders, then the local recurrence of her breast cancer would be seen as not being a contributor to her death.
Since most elderly cancer patients have hormone-receptor-positive breast cancer, the doctor may very well recommend that the patient be given hormonal therapy for prevention of recurrence. There are even times when the recommendation will be to do no surgery at all but to instead treat the breast cancer only with hormonal therapy. This enables the disease to be controlled without having to subject the patient to invasive procedures that may carry more risk than benefit.
So why can't all women decide to forego surgery, chemo, and other recommended treatments, and just take a pill each day to keep the breast cancer small or make it shrink?
It all goes back to the prognosis. For most women diagnosed with breast cancer, we are surely hoping that they will live decades more and, along with that longevity, experience a good quality of life. Under-treating the disease for someone like this could jeopardize her chances of dying of old age. The mission is to rid you of the disease and to maintain your quality of life as a long-term survivor.
Say you or a loved one has been newly diagnosed with breast cancer and you or she has other medical problems as well, conditions that are quite concerning and that have weighed heavily on your/her health condition for some time. In a case like this, you can anticipate that a medical oncologist will be making decisions along with the breast surgeon about what a reasonable treatment should consist of for controlling the breast cancer.
You can request that the decision-making process be expanded to include other health care providers. Here at Johns Hopkins, a patient can request that her case be presented to our Breast Center's weekly tumor board meeting for a multidisciplinary discussion. This enables other physicians and nurses to weigh in with their thoughts regarding the best course to take.
There are medical oncologists who specialize in what is called "geri-oncology," or the treatment of cancer among older individuals. Don't hesitate to seek out such a doctor if you are elderly and find yourself needing this level of specialization and expertise.
