Breast Cancer and Seniors
Last Updated: April 2, 2013
When detected early, breast cancer is treated successfully 98%
of the time. Researchers continue to make impressive gains in the
detection, diagnosis, and treatment of breast cancer. For example,
according to the Mayo Clinic, the radical mastectomy, once a
standard procedure for women with breast cancer, is now rarely
However, breast cancer in seniors remains a very potent disease
that will only be eradicated if women follow the recommended
schedule and undergo annual mammograms. Recent statistics suggest
that women are skipping annual mammograms, the key procedure to
The National Cancer Institute estimates that 226,870 women will
be diagnosed with and 39,510 women will die of cancer of
the breast in 2012. The number of new cases has increased
every year for the past thirty years, though death from breast
cancer has decreased slightly. Breast cancer remains the second
leading cause of cancerous death after lung cancer. It is also the
second most common cancer among women after non-melanoma skin
Like all cancers, breast cancer begins with abnormal cell
growth. These "bad" cells develop too quickly and spread, or
metastasize, throughout the breast, often entering lymph nodes
located under the arm or even moving into other parts of the
There are several signs of potential breast cancer, including a
bloody discharge from or retraction of the nipple; a change in the
size or contour of the breast; and a flattening, redness, or
pitting of skin over the breast. A lump in the breast remains the
most common sign.
If a woman detects a lump, she should see her doctor; however,
the Mayo Clinic recommends waiting through one menstrual cycle, as
breast shape changes throughout the cycle.
The Importance of Screening
"I cannot stress enough the importance of early detection and
screening," states Dr. Constance Lehman, professor of radiology at
the University of Washington School of Medicine and director of
breast imaging at the Seattle Cancer Care Alliance.
Unfortunately, Lehman sees a disturbing decline in annual
"Cancer is affecting more and more women, yet they are screening
less," she says. "It could be due to the costs of an annual
mammogram for women with low or no health insurance or because,
with new technology like targeted MRIs, women feel that mammography
is no longer effective."
Lehman says clinicians may also be partially responsible. Some,
including all major cancer research centers, recommend annual
screenings but others suggest a biannual exam. Lehman, co-winner of
the Second Annual Ladies' Home Journal"Health Breakthrough Award,"
remains unequivocal: "There is no ambiguity-women past the age of
40 should be screened every year."
Several primary risk factors are believed to increase the
likelihood of breast cancer. However, it's important to keep in
mind that most people with one or even several of these risk
factors do not get breast cancer.
The Mayo Clinic and National Cancer Institute list these primary
- Chest radiation as a child
- Start of menarche before the age of 12
- Adolescent weight gain
- No pregnancy or late pregnancy (after 30)
- Lengthy use of oral contraceptives
- Post-menopausal weight gain
- Late menopause (after age of 50)
- Increased breast tissue density
Excessive exposure to estrogen, the hormone that promotes the
appearance of female secondary sex characteristics, appears to be
the leading factor in developing breast cancer. Exposure to a
combination of estrogen and progesterone for over a four-year
period also increases the risk of breast cancer. This is especially
significant due to trends in estrogen therapies to stave off
premenopausal syndrome and other maladies. The more recent
reduction of hormone replacement therapy has perhaps led to the
recent slight decline in breast cancer cases for women over 50.
Lehman believes women over 50 should consult their physicians about
the apparent risks of hormone replacement therapies, especially if
they have a family history of cancer.
Secondary factors, including smoking, obesity, alcohol, family
history, diet, and stress, are also significant. As with reducing
the risk of all cancers, a healthy lifestyle, including a good
diet, frequent exercise, and moderate stress, is recommended.
Genetics may also play a role in breast cancer. Even though less
than 10 percent of the breast cancer cases are inherited, women
with a family history of the disease have a much greater risk of
breast (and ovarian) cancer.
Breast Cancer in Seniors
Eighty percent of all breast cancer occurs in women over 50, and
60 percent are found in women over 65. The chance that a woman will
get breast cancer increases from 1-in-233 for a woman in her
thirties, to a 1-in-8 chance for a woman in her eighties.
"The average age of diagnosis is 62," says Dr. Julie Gralow,
associate professor of medical oncology at the University of
Washington School of Medicine and medical oncologist at the Seattle
Cancer Care Alliance. "So the majority of women getting breast
cancer are over the age of 50."
Gralow is especially concerned about the lack of women over 70
years of age in clinical trials.
"There are several situations unique to our older patients. We
find it difficult to determine the toxicity levels of
chemotherapy," she explains, "because we simply don't have enough
information. This is significant because older women tend to have
more tumors and thus be more sensitive to estrogen receptor
positivity; or they might avoid chemotherapy altogether."
Lack of information is just one of several issues surrounding
cancer in seniors. An obligation as routine as visiting the
doctor can prove challenging if the patient cannot drive or does
not have anyone to take her to the appointment. This is quite
significant with cancer treatment, as the patient must make
six-to-eight weeks of daily trips to the hospital for radiation
"Nausea and other side effects are often much more severe with
older patients," explains Gralow. "And insurance of oral medicine
can be spotty, especially if the patient depends upon
Gralow also notes the possible tensions between family
involvement and doctor-patient discretion.
"I need to know what the patient wants shared because we need to
respect patient privacy while keeping the family informed. So, as
with all medicine, we try to bring the patient and her family
together for a meeting at the start of the treatment."
Find Senior Living Communities
Once cancer has been detected, the patient's team of doctors
will determine its stage and publish a comprehensive report. This
highly detailed report should include everything from locations and
descriptions of each tissue sample to the patient's clinical
history with the disease so far, according to the nonprofit website
Breast cancer treatment varies according to the stage of the
cancer, or number and range of the malignant cells. The treatment
regimen will also vary by organization, another reason why it's so
important to get a second opinion during every stage of the cancer
The four traditional treatments include:
- Radiation Therapy
- Hormone Therapy
Surgerywas considered the primary treatment for breast cancer
for over 100 years. Only recently has this approach changed, as new
first response therapies have evolved and doctors have begun to
implement targeted treatment strategies in many cases. Surgery
still remains an important option, however.
Lumpectomyis the least invasive surgical procedure, as only the
tumor is removed. Lumpectomies are recommended when there is no
sign of the cancer spreading to other sections of the breast or
body. It is commonly followed by five-to-seven weeks of radiation
therapy as a precaution.
There are three levels ofmastectomy, or removal of the
breast.Total mastectomyresults in the complete removal of the
breast. Amodified radical mastectomy, the most common surgical
procedure, includes removal of the breast and the auxiliary lymph
nodes.Radical mastectomy, long the standard procedure, requires
removal of the entire breast, underarm lymph nodes and chest wall
beneath the breast. After the surgery, doctors examine samples from
each tissue group to determine further treatment, though radiation
therapy is a routine follow-up procedure.
Radiation therapy, the use of intense light rays to kill cancer
cells, has a 50-70 percent chance of reducing recurrence, according
to the National Cancer Institute. Though less uncomfortable than
most patients realize, radiation kills cancer and healthy cells in
"We are beginning to reduce the length and intensity of
radiation treatments, because of the development and continued
improvement of targeted therapies," Gralow explains. "In general,
we are trending toward less toxic, less invasive therapies."
Chemotherapyis a systematic, or whole body, treatment designed
to kill cancer cells that have spread to anywhere in the body.
Chemotherapy attacks rapidly dividing cells, both cancer and
healthy cells, though recent developments have worked to reduce the
infamous side effects. It is important to note that every
chemotherapy treatment regimen is unique and depend upon many
factors including patient and family medical history, current
health and numerous other factors.
Hormone therapy, the use of certain hormones that attack cancer
cells, is a systematic treatment designed to rid the entire body of
cancer. Doctors use drugs to inhibit estrogen or progesterone from
developing breast cancer cell growth or, in some cases, turn off
production of ovarian hormones.
Hormone therapy is commonly used when the patient is
hormone-receptor positive. It can be used to lower risk of the
cancer's occurrence for women at high risk, to lower the risk of
recurrence, to shrink a large tumor, or to treat advanced
There is also a newly developed regimen calledimmune targeted
therapy, which mimics natural antibodies that attack specific
characteristics of the cancer cell. Targeted therapies are added to
chemotherapy, though researchers are also developing techniques to
reduce the intensity of chemotherapy and even potentially
eliminating it from the treatment regimen.
Gralow and Lehman both believe ongoing developments in hormone
and other new therapies will greatly change the treatment of breast
cancer in the future. The National Cancer Institute describes
several. For example, the removal of the sentinel lymph nodes, the
first node where the tumor is likely to spread, would prove a less
invasive technique to stem the spread of the cancer.
A combination of high dose chemotherapy and replacement of the
destroyed cells with a stem cell transplant is also in development,
though the technique is as yet unproven. Use of certain kinase
inhibitors that block the signals that tumors require to grow are
also under study.
"There are some exciting changes in how we approach treatment,"
Lehman says, "So if you are diagnosed with breast cancer you should
go to a medical center with an expert reputation."
"Andalwaysget a second opinion for your treatment regimen," she
"We are personalizing breast cancer," says Gralow. She points to
genetic research that targets specific cancer genes as well as
genomic profiling to assess cancer relapse risk, which can help to
reduce the use of chemotherapy in patients.
Gralow includes several other examples of research
breakthroughs, including the use of MRI screening to detect
preinvasive cancers and the reduction by half from six to three
weeks of the radiation sequence, as patients receive a higher dose
for a shorter period. This would greatly help with older patients,
for whom attending six-to-eight weeks of daily treatment often
proves a challenge. New targeted drugs like Herceptin®,
effective thus far in 20-25 percent of patients and displaying
diminishing toxicity, is also leading to wholesale changes in
"The lack of volunteers in study groups remains a significant
obstacle in the development of therapy success rates for older
patients," states Gralow. "I would encourage older women to enroll
in these trials, as they often receive new therapies and important
information otherwise unavailable."