Management of breast cancer in the elderly by complete local excision and tamoxifen alone

Background: Breast cancer in the elderly is a significant problem, with sim ilar to 30% of all breast cancers occurring in women who are aged 70 or mor e. Treatments such as axillary dissection, radiotherapy and chemotherapy, p art of standard therapy in younger women, have a considerable morbidity and may not be well tolerated in the elderly. The authors report their experie nce with a more conservative approach to breast cancer in the elderly, usin g complete local excision combined with long-term tamoxifen (CLE and Tam). Methods: Seventy women aged greater than or equal to 70 years (median age: 79.5 years; range: 70-93 years) were treated by CLE and Tam, and were follo wed for a median of 25 months (range: 1-82 months). The study population of 70 women represented a less fit group, with tumours suitable for a breast- conserving approach and without palpable axillary lymph nodes. Follow-up wa s by clinical examination and annual mammography. Results: Loco-regional failure occurred in seven women (10%), three of whic h involved the breast alone, three the axilla alone, and one involved both sites. Five patients had further surgery. Six of the seven patients had hig h-grade tumours and two of them were oestrogen receptor-negative. Four of t he failure group have subsequently died: two with metastatic breast cancer and two from non-malignant disease. Of the whole study group, there have be en 12 deaths in the follow-up period: three from metastatic breast cancer a nd nine from unrelated medical illness. Conclusions: It is believed that CLE and Tam provide a simple and safe appr oach for early non-high-grade boast cancers in elderly women. By such an ap proach, a large number of elderly women can avoid axillary dissection and r adiotherapy.