DIAGNOSIS AND THERAPY OF BREAST-CANCER IN ELDERLY WOMEN

Because of its high incidence and the high number of deaths induced, b reast cancers in elderly women is a major health problem. The diagnosi s is often clinical and the tumors are often at advanced stage with ma ny initial metastases due to some neglect, Breast cancer in elderly wo men has no specific radiological form and is more often infiltrating d uctal carcinoma of SBR grade I. Hormonal receptors are generally highe r in elderly than in young women, Surgery of breast cancers with equal anesthetic risks factors does not induce more complications in elderl y women than in the general population, In 12% of cases, an associated pathology influences the decision (degradation of the respiratory or cardiovascular function or reduction of the renal function). Between 7 0 and 80 years, provided that life expectancy is compatible with radio therapy, corollary to conservative treatments in the present state of our knowledge for tumors under 3 to 4 cm, there is an alternative betw een radiosurgical conservative treatment and modified mastectomy assoc iated with axillary dissection. In case of bulky tumors (> 3 to 4 cm) and failure of the hormonal treatment or impossibility to perform a co mplementary radiotherapy treatment (for instance, senile dementia), of axillary node involvement, a fortiori if the tumor has no hormonal re ceptors, the modified mastectomy with axillary dissection remains the therapeutic standard, In case of bulky tumor, the hormonal status can be used to induce the patient to accept an operation and, if necessary , to perform a conservative surgery, However, despite hormonosensitivi ty of breast cancer, a tumoral progression after a mean duration of ho rmonosensitivity of 25 months is to be expected in 93% of the cases, i ncluded 25% in whom a complete response to hormonotherapy was observed , A fractionated irradiation delivering 2 Gy per fraction and 5 fracti ons per week with a total number of sessions of 25 gives better esthet ical results. This optimal treatment lasts 5 weeks and the patients of ten get tired since they are old and their radiotherapy centre is far from their house, Therefore hypofractionated treatment (once a week) s hould be proposed, The adjuvant medical treatment of reference for men opausal women is hormonotherapy by tamoxifen. Breast cancer in elderly women reduces life expectancy at 5 years by 50%; the theoretical ther apeutic indications are the same as for young women, but their applica tion is adapted to the patient, It would be dangerous and illusive to undertreat such a disease when the life expectancy is longer than 3 ye ars.