Older breast cancer patients: challenges facing oncologists

The population of older patients is rapidly growing across the globe. As breast cancer prevalence increases with age, a disproportionate number of older women will be affected by this disease which is highly curable if diagnosed early (1). Yet, breast cancer in older women are frequently diagnosed late because screening mammogram are frequently stopped at the age of 75 (2). Adding insult to injury, Oncologists are frequently biased because of the patient chronological age and would most likely recommend a less aggressive course of treatment even though it may be curative (3). This conservative approach is frequently not based on clinical factors such as frailty index but guided by physicians fear of harming the patient because of data paucity as older breast cancer patients are frequently excluded from clinical trials (4).

The manuscripts included in this special topic highlight the fact that radiotherapy is very well tolerated in older cancer patients. Side effects and complications rates are minimal because advanced radiotherapy techniques such as image-guided radiotherapy and stereotactic body radiotherapy allow the clinician to reduce radiotherapy dose to the organs at risk for complications such as the heart and lungs (5). A short course of radiotherapy may be ideal for older breast cancer patients because of reduced cost while minimizing the inconvenience associated with daily transportation (6). Excellent loco-regional control is reported by different institutions across the world in this special topic and in cases of oligometastases, the chance for improving the patient quality of life (7). Thus, each patient case should be discussed by a team of trained specialists familiar with the management of older cancer patients such as surgical, medical, radiation oncologists, and geriatricians. A consensus should be reached based on patient physical and mental status, and potential biomarkers to maximize patient outcome instead of chronological age (8).

There is hope in the future if we educate clinicians on how to make rational decision and to conduct prospective randomized trials which would guide us to provide the best care for this aging patient population with multiple co-morbidity. This process may be optimized by inviting international collaboration across the borders to obtain a large pool of patients from various ethnic background and to generate an international data bank where artificial intelligence may create an algorithm on how best to manage older breast cancer patients (9).

Acknowledgments

The authors thank Dayleen De Riggs for her help in editing the manuscript.

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Translational Cancer Research for the series “Radiotherapy for Breast Cancer in Advanced Age”. The article did not undergo external peer review.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2020.01.05). The series “Radiotherapy for Breast Cancer in Advanced Age” was commissioned by the editorial office without any funding or sponsorship. VVH served as the unpaid Guest Editor of the series and serves as an unpaid editorial board member of Translational Cancer Research from Jul 2018 to Jun 2020. NPN served as the unpaid Guest Editor of the series. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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