Morrow M
Department of Surgery, Northwestern University School of Medicine, Chicago, Illinois.
Surg Clin North Am. 1994 Feb;74(1):145-61. doi: 10.1016/s0039-6109(16)46233-x.
Breast cancer incidence and mortality increase with advancing age. In spite of this, screening for breast cancer by physical examination and mammography is underutilized in older women compared with their younger counterparts. Studies suggest that even for elderly women with mild to moderate co-existing illnesses, the use of screening mammography reduces breast cancer mortality. The local therapy of breast cancer is well tolerated by the majority of elderly women. Mastectomy has a 30-day operative mortality of less than 1% in women older than age 65 and provides excellent local control. However, mastectomy has no survival advantage over lumpectomy and radiotherapy. If breast preservation is undertaken, radiotherapy is an important part of the treatment. Local failure in the breast in the absence of radiotherapy usually occurs in the first 4 postoperative years and is likely to become a problem during the patient's lifetime. Radiation to the breast is well tolerated, and the incidence of complications does not appear to be age related. Many older women are anxious to preserve their breasts and should be offered this treatment option. In the older woman with severe co-morbid conditions in whom the risk of operative morbidity and mortality is high, tamoxifen, 20 mg daily, may be used as an alternative to surgical therapy. Complete and partial response rates of 50% to 80% are reported with tamoxifen therapy, and this often results in control of local disease during the patient's lifetime. However, this should not be considered standard therapy for the otherwise healthy older woman. The majority of older women benefit from tamoxifen therapy postoperatively, and cytotoxic chemotherapy, when indicated, can be delivered with acceptable toxicity. The failure to use adjuvant therapy when indicated is one of the most frequently identified problems in the management of breast cancer in the elderly. Breast cancer in older women carries a significant mortality, even in spite of the presence of concurrent diseases. In a number of studies, old age is noted to be a negative prognostic factor. Whether this is due to the biology of the disease or the undertreatment of older women is unclear, but it is evident that breast cancer in the elderly should not be considered an indolent disease. Breast cancer therapy should be determined by a woman's physiologic age and psychological needs rather than her chronologic age.
乳腺癌的发病率和死亡率随年龄增长而上升。尽管如此，与年轻女性相比，老年女性通过体格检查和乳房X线摄影进行乳腺癌筛查的利用率较低。研究表明，即使对于患有轻度至中度并存疾病的老年女性，使用乳房X线摄影筛查也能降低乳腺癌死亡率。大多数老年女性对乳腺癌的局部治疗耐受性良好。对于65岁以上的女性，乳房切除术的30天手术死亡率低于1%，并能提供良好的局部控制。然而，乳房切除术与乳房肿瘤切除术加放疗相比并无生存优势。如果选择保乳治疗，放疗是治疗的重要组成部分。在没有放疗的情况下，乳房局部复发通常发生在术后的前4年，并且很可能在患者的一生中成为一个问题。乳房放疗耐受性良好，并发症的发生率似乎与年龄无关。许多老年女性渴望保留乳房，应该为她们提供这种治疗选择。对于患有严重并存疾病、手术发病率和死亡率风险较高的老年女性，每天服用20毫克他莫昔芬可作为手术治疗的替代方案。据报道，他莫昔芬治疗的完全缓解率和部分缓解率为50%至80%，这通常能在患者的一生中控制局部疾病。然而，这不应被视为健康老年女性的标准治疗方法。大多数老年女性术后从他莫昔芬治疗中获益，并且在有指征时，细胞毒性化疗可以在可接受的毒性水平下进行。在老年乳腺癌管理中，未能在有指征时使用辅助治疗是最常发现的问题之一。即使存在并存疾病，老年女性的乳腺癌也具有显著的死亡率。在一些研究中，年龄被认为是一个负面的预后因素。这是由于疾病的生物学特性还是老年女性治疗不足尚不清楚，但很明显，老年乳腺癌不应被视为一种惰性疾病。乳腺癌治疗应根据女性的生理年龄和心理需求而非实际年龄来确定。
