Law T M, Hesketh P J, Porter K A, Lawn-Tsao L, McAnaw R, Lopez M J
St. Elizabeth's Medical Center, Boston, USA.
Surg Clin North Am. 1996 Apr;76(2):289-308. doi: 10.1016/s0039-6109(05)70440-0.
Recent data suggest that breast cancer in elderly women does not present as more advanced disease, nor is survival significantly inferior to that in younger women. Unfortunately, until recently, older women have been excluded from clinical trials that have determined survival benefit in both screening and treatment modalities. Unless co-morbid conditions adversely affect one's life expectancy or tolerance to therapy, older women should be treated with standard surgical procedures (including breast conservation, if so desired) for early-stage disease, as outcome is comparable to that in younger patients. Adjuvant tamoxifen therapy has proven survival benefit in women over 70 years of age with estrogen receptor-positive tumors and should be considered in all women with tumors greater than 1 cm in size. Older women may experience more chemotherapy-related toxicities. However, for those with a significant risk of recurrence due to tumor size or lymph node status, chemotherapy can be safely administered when factors such as age-related decline in creatinine clearance and co-morbid conditions are considered. Hormonal therapy (tamoxifen) is usually the first-line treatment option over chemotherapy for metastatic disease in the elderly unless the patient has an estrogen receptor-negative tumor, visceral-dominant disease, or significant disease-related symptoms. In the latter settings, chemotherapy can provide improved or more rapid response proportions but does not affect long-term survival.
近期数据表明，老年女性乳腺癌并非表现为更晚期的疾病，其生存率也并不显著低于年轻女性。不幸的是，直到最近，老年女性一直被排除在那些确定了筛查和治疗方式生存获益的临床试验之外。除非合并症对预期寿命或治疗耐受性产生不利影响，否则早期疾病的老年女性应接受标准手术治疗（包括保乳手术，若有此需求），因为其治疗结果与年轻患者相当。辅助性他莫昔芬治疗已被证明对年龄超过70岁、雌激素受体阳性肿瘤的女性有生存获益，所有肿瘤大小超过1厘米的女性都应考虑使用。老年女性可能会经历更多与化疗相关的毒性反应。然而，对于那些因肿瘤大小或淋巴结状态而有显著复发风险的患者，在考虑诸如肌酐清除率随年龄下降和合并症等因素时，可以安全地进行化疗。对于老年转移性疾病患者，激素治疗（他莫昔芬）通常是优于化疗的一线治疗选择，除非患者患有雌激素受体阴性肿瘤、以内脏为主的疾病或有明显的疾病相关症状。在后一种情况下，化疗可以提供更高的缓解率或更快的反应率，但不影响长期生存。
