Adjuvant therapy of breast cancer in women 70 years of age and older: tough decisions, high stakes.

In most Western nations, the incidence and mortality rates for breast cancer rise dramatically with increasing age, and in the coming decades oncologists will be faced with managing an increasing number of older patients with breast cancer. Having the knowledge and tools to optimally treat this group will be essential. The challenge of caring for an older cancer patient is to provide treatment options that maximize long-term survival and account for life expectancy, comorbidities, and the effects of treatment on function. For example, a mild treatment-induced peripheral neuropathy can transform a functioning elder into one who is dependent on institutional care. Complicating matters, there is a paucity of data from randomized trials on the risks and benefits of our newer and increasingly effective treatments in older breast cancer patients. In this review we will discuss how to evaluate older breast cancer patients, including estimating survival, defining functional limitations, and providing guidelines for optimal adjuvant therapies.