Kimmick G G, Muss H B
Comprehensive Cancer Center of Wake Forest University, Winston-Salem, North Carolina, USA.
Oncology (Williston Park). 2001 Mar;15(3):280-91; discussion 291-2, 295-6, 299.
Breast cancer is a common problem in older women. As the number of medical illnesses increases with age and the life expectancy decreases, the benefits of systemic therapy for women with breast cancer become questionable. All women over age 65 years are at high enough risk of breast cancer to consider the risk/benefit ratio of preventive therapy with tamoxifen (Nolvadex) or participation in the Study of Tamoxifen and Raloxifene (STAR) trial. Adjuvant chemotherapy and hormonal therapies for early breast cancer significantly improve disease-free and overall survival; recommendations for their use are based on risk of tumor recurrence. Use of tamoxifen in the adjuvant setting in women with receptor-positive tumors is a relatively simple decision in light of its favorable toxicity profile. The delivery of adjuvant chemotherapy is a more complicated decision, and the patient's wishes, estimated life expectancy, presence of comorbid conditions, and estimated benefit from treatment should be considered. The primary goal of the treatment of metastatic breast cancer is palliation. We discuss trials specific to older women and make appropriate treatment recommendations. Unfortunately, there is a paucity of data from clinical trials in women over age 70 years. However, because the clinical trial is the primary scientific mechanism for testing the efficacy of a treatment, every effort should be made to enter older women into treatment protocols.
乳腺癌是老年女性中的常见问题。随着年龄增长，疾病数量增加且预期寿命缩短，乳腺癌女性进行全身治疗的益处变得值得怀疑。所有65岁以上的女性患乳腺癌的风险足够高，需要考虑使用他莫昔芬（诺瓦得士）进行预防性治疗的风险/获益比，或参与他莫昔芬与雷洛昔芬研究（STAR）试验。早期乳腺癌的辅助化疗和激素疗法可显著改善无病生存期和总生存期；其使用建议基于肿瘤复发风险。鉴于其良好的毒性特征，对于受体阳性肿瘤的女性在辅助治疗中使用他莫昔芬是一个相对简单的决定。辅助化疗的实施是一个更复杂的决定，应考虑患者的意愿、预期寿命、合并症情况以及估计的治疗获益。转移性乳腺癌治疗的主要目标是缓解症状。我们讨论针对老年女性的试验并给出适当的治疗建议。不幸的是，70岁以上女性的临床试验数据匮乏。然而，由于临床试验是检验治疗效果的主要科学机制，应尽一切努力让老年女性参与治疗方案。
