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Breast Cancer in the Older Adult

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Management of Breast Diseases

Abstract

Breast cancer is the most common cancer among women over the age of 65 years. The objectives of this chapter are to review the value of clinical assessment tools for older adults with breast cancer and to discuss breast cancer prevention, screening, and treatment specific for older adults. The geriatric assessment is an important tool that oncologists can use to better assess an older adult’s functional age and provides additional information beyond standard performance status measures. The geriatric assessment has been shown to uncover problems not detected in a routine oncologic evaluation and also aids in predicting treatment-related toxicity in older adults with solid tumors. Healthy older women with breast cancer should be managed like younger postmenopausal women, including breast conservation therapy if feasible and adjuvant systemic therapy. Frail older women and those with significant comorbidity frequently require treatment modifications. Older women with breast cancer should be routinely encouraged to participate in clinical trials to further develop evidence-based practices for the management and treatment of breast cancer in older adults.

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References

  1. Institute NC. SEER stat fact sheets: breast cancer 2015 [cited 2015 October 5]. Available from: http://seer.cancer.gov/statfacts/html/breast.html.

  2. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2009;27(17):2758–65.

    Article  Google Scholar 

  3. Lyman GH, Lyman S, Balducci L, Kuderer N, Reintgen D, Cox C, et al. Age and the risk of breast cancer recurrence. Cancer Control: J Moffitt Cancer Center. 1996;3(5):421–7.

    CAS  Google Scholar 

  4. Masetti R, Antinori A, Terribile D, Marra A, Granone P, Magistrelli P, et al. Breast cancer in women 70 years of age or older. J Am Geriatr Soc. 1996;44(4):390–3.

    Article  CAS  PubMed  Google Scholar 

  5. Yancik R, Wesley MN, Ries LA, Havlik RJ, Edwards BK, Yates JW. Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA. 2001;285(7):885–92.

    Article  CAS  PubMed  Google Scholar 

  6. Hebert-Croteau N, Brisson J, Latreille J, Blanchette C, Deschenes L. Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women. Cancer. 1999;85(5):1104–13.

    Article  CAS  PubMed  Google Scholar 

  7. Eaker S, Dickman PW, Bergkvist L, Holmberg L. Uppsala/Orebro breast cancer G. Differences in management of older women influence breast cancer survival: results from a population-based database in Sweden. PLoS Med. 2006;3(3):e25.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hebert-Croteau N, Brisson J, Latreille J, Rivard M, Abdelaziz N, Martin G. Compliance with consensus recommendations for systemic therapy is associated with improved survival of women with node-negative breast cancer. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2004;22(18):3685–93.

    Article  Google Scholar 

  9. Hutchins LF, Unger JM, Crowley JJ, Coltman CA Jr, Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341(27):2061–7.

    Article  CAS  PubMed  Google Scholar 

  10. Sateren WB, Trimble EL, Abrams J, Brawley O, Breen N, Ford L, et al. How sociodemographics, presence of oncology specialists, and hospital cancer programs affect accrual to cancer treatment trials. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2002;20(8):2109–17.

    Article  Google Scholar 

  11. Kemeny MM, Peterson BL, Kornblith AB, Muss HB, Wheeler J, Levine E, et al. Barriers to clinical trial participation by older women with breast cancer. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2003;21(12):2268–75.

    Article  Google Scholar 

  12. Trimble EL, Carter CL, Cain D, Freidlin B, Ungerleider RS, Friedman MA. Representation of older patients in cancer treatment trials. Cancer. 1994;74(7 Suppl):2208–14.

    Article  CAS  PubMed  Google Scholar 

  13. Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285(21):2750–6.

    Article  CAS  PubMed  Google Scholar 

  14. Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. Index to predict 5-year mortality of community-dwelling adults aged 65 and older using data from the National Health Interview Survey. J Gen Intern Med. 2009;24(10):1115–22.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cruz M, Covinsky K, Widera EW, Stijacic-Cenzer I, Lee SJ. Predicting 10-year mortality for older adults. JAMA. 2013;309(9):874–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Hurria A, Gupta S, Zauderer M, Zuckerman EL, Cohen HJ, Muss H, et al. Developing a cancer-specific geriatric assessment: a feasibility study. Cancer. 2005;104(9):1998–2005.

    Article  PubMed  Google Scholar 

  17. Williams GR, Deal AM, Jolly TA, Alston SM, Gordon BB, Dixon SA, et al. Feasibility of geriatric assessment in community oncology clinics. J Geriatr Oncol. 2014;5(3):245–51.

    Article  PubMed  Google Scholar 

  18. Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2007;25(14):1824–31.

    Article  Google Scholar 

  19. Jolly TA, Deal AM, Nyrop KA, Williams GR, Pergolotti M, Wood WA, et al. Geriatric assessment-identified deficits in older cancer patients with normal performance status. Oncologist. 2015;20(4):379–85.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross CP, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2011;29(25):3457–65.

    Article  CAS  Google Scholar 

  21. Extermann M, Boler I, Reich RR, Lyman GH, Brown RH, DeFelice J, et al. Predicting the risk of chemotherapy toxicity in older patients: the chemotherapy risk assessment scale for high-age patients (CRASH) score. Cancer. 2012;118(13):3377–86.

    Article  PubMed  Google Scholar 

  22. Maas HA, Janssen-Heijnen ML, Rikkert MGO, Wymenga ANM. Comprehensive geriatric assessment and its clinical impact in oncology. Eur J cancer. 2007;43(15):2161–9.

    Google Scholar 

  23. Extermann M, Aapro M, Bernabei R, Cohen HJ, Droz JP, Lichtman S, et al. Use of comprehensive geriatric assessment in older cancer patients: recommendations from the task force on CGA of the International Society of Geriatric Oncology (SIOG). Crit Rev Oncol/Hematol. 2005;55(3):241–52.

    Article  Google Scholar 

  24. Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med. 1994;120(2):104–10.

    Article  CAS  PubMed  Google Scholar 

  25. La Vecchia C, Negri E, Franceschi S, Talamini R, Bruzzi P, Palli D, et al. Body mass index and post-menopausal breast cancer: an age-specific analysis. Br J Cancer. 1997;75(3):441–4.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Senie RT, Rosen PP, Rhodes P, Lesser ML, Kinne DW. Obesity at diagnosis of breast carcinoma influences duration of disease-free survival. Ann Intern Med. 1992;116(1):26–32.

    Article  CAS  PubMed  Google Scholar 

  27. Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90(18):1371–88.

    Article  CAS  PubMed  Google Scholar 

  28. Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA. 2006;295(23):2727–41.

    Article  CAS  PubMed  Google Scholar 

  29. Goss PE, Ingle JN, Ales-Martinez JE, Cheung AM, Chlebowski RT, Wactawski-Wende J, et al. Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med. 2011;364(25):2381–91.

    Article  CAS  PubMed  Google Scholar 

  30. Gail MH, Costantino JP, Bryant J, Croyle R, Freedman L, Helzlsouer K, et al. Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer. J Natl Cancer Inst. 1999;91(21):1829–46.

    Article  CAS  PubMed  Google Scholar 

  31. Humphrey LL, Helfand M, Chan BK, Woolf SH. Breast cancer screening: a summary of the evidence for the U.S. preventive services task force. Ann Intern Med. 2002;137(5 Part 1):347–60.

    Google Scholar 

  32. Walter LC, Schonberg MA. Screening mammography in older women: a review. JAMA. 2014;311(13):1336–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Badgwell BD, Giordano SH, Duan ZZ, Fang S, Bedrosian I, Kuerer HM, et al. Mammography before diagnosis among women age 80 years and older with breast cancer. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2008;26(15):2482–8.

    Article  Google Scholar 

  34. Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer screening in the United States, 2010: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2010;60(2):99–119.

    Article  PubMed  Google Scholar 

  35. Audisio RA, Bozzetti F, Gennari R, Jaklitsch MT, Koperna T, Longo WE, et al. The surgical management of elderly cancer patients; recommendations of the SIOG surgical task force. Eur J Cancer. 2004;40(7):926–38.

    Article  CAS  PubMed  Google Scholar 

  36. Kemeny MM. Surgery in older patients. Semin Oncol. 2004;31(2):175–84.

    Article  PubMed  Google Scholar 

  37. Figueiredo MI, Cullen J, Hwang YT, Rowland JH, Mandelblatt JS. Breast cancer treatment in older women: does getting what you want improve your long-term body image and mental health? J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2004;22(19):4002–9.

    Article  Google Scholar 

  38. Hind D, Wyld L, Beverley CB, Reed MW. Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus). Cochrane Database Syst Rev. 2006(1):CD004272.

    Google Scholar 

  39. Clarke M, Collins R, Darby S, Davies C, Elphinstone P, Evans V, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.

    Article  CAS  PubMed  Google Scholar 

  40. Hughes KS, Schnaper LA, Berry D, Cirrincione C, McCormick B, Shank B, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med. 2004;351(10):971–7.

    Article  CAS  PubMed  Google Scholar 

  41. Kunkler IH, Williams LJ, Jack WJ, Cameron DA, Dixon JM, investigators PI. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol. 2015;16(3):266–73.

    Google Scholar 

  42. VanderWalde N, Hebert B, Jones E, Muss H. The role of adjuvant radiation treatment in older women with early breast cancer. J Geriatr Oncol. 2013;4(4):402–12.

    Article  PubMed  Google Scholar 

  43. Wyckoff J, Greenberg H, Sanderson R, Wallach P, Balducci L. Breast irradiation in the older woman: a toxicity study. J Am Geriatr Soc. 1994;42(2):150–2.

    Article  CAS  PubMed  Google Scholar 

  44. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med. 2003;349(6):546–53.

    Article  PubMed  Google Scholar 

  45. Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg VS, Shriver C, et al. The sentinel node in breast cancer–a multicenter validation study. N Engl J Med. 1998;339(14):941–6.

    Article  CAS  PubMed  Google Scholar 

  46. Gennari R, Rotmensz N, Perego E, dos Santos G, Veronesi U. Sentinel node biopsy in elderly breast cancer patients. Surg Oncol. 2004;13(4):193–6.

    Article  PubMed  Google Scholar 

  47. Early Breast Cancer Trialists’ Collaborative. G. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet Oncol. 2005;365:1687–717.

    Article  Google Scholar 

  48. Diab SG, Elledge RM, Clark GM. Tumor characteristics and clinical outcome of elderly women with breast cancer. J Natl Cancer Inst. 2000;92(7):550–6.

    Article  CAS  PubMed  Google Scholar 

  49. Grann VR, Troxel AB, Zojwalla NJ, Jacobson JS, Hershman D, Neugut AI. Hormone receptor status and survival in a population-based cohort of patients with breast carcinoma. Cancer. 2005;103(11):2241–51.

    Article  CAS  PubMed  Google Scholar 

  50. Crivellari D, Aapro M, Leonard R, von Minckwitz G, Brain E, Goldhirsch A, et al. Breast cancer in the elderly. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2007;25(14):1882–90.

    Article  Google Scholar 

  51. Jenkins EO, Deal AM, Anders CK, Prat A, Perou CM, Carey LA, et al. Age-specific changes in intrinsic breast cancer subtypes: a focus on older women. Oncologist. 2014;19(10):1076–83.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Toikkanen S, Kujari H. Pure and mixed mucinous carcinomas of the breast: a clinicopathologic analysis of 61 cases with long-term follow-up. Hum Pathol. 1989;20(8):758–64.

    Article  CAS  PubMed  Google Scholar 

  53. de Glas NA, van de Water W, Engelhardt EG, Bastiaannet E, de Craen AJ, Kroep JR, et al. Validity of Adjuvant! Online program in older patients with breast cancer: a population-based study. Lancet Oncol. 2014;15(7):722–9.

    Google Scholar 

  54. Karuturi M, vanderWalde A, Muss HB. Approach and management of breast cancer in the elderly. Clin Geriatr Med. 2015; in press.

    Google Scholar 

  55. Biganzoli L, Wildiers H, Oakman C, Marotti L, Loibl S, Kunkler I, et al. Management of elderly patients with breast cancer: updated recommendations of the International Society of Geriatric Oncology (SIOG) and European Society of Breast Cancer Specialists (EUSOMA). Lancet Oncol. 2012;13(4):e148–60.

    Article  PubMed  Google Scholar 

  56. Williams GR, Jones E, Muss HB. Challenges in the treatment of older breast cancer patients. Hematol Oncol Clin North Am. 2013;27(4):785–804.

    Article  PubMed  Google Scholar 

  57. Paik S, Shak S, Tang G, Kim C, Baker J, Cronin M, et al. A multigene assay to predict recurrence of tamoxifen-treated, node-negative breast cancer. New Engl J Med. 2004;351(27):2817–26.

    Article  CAS  PubMed  Google Scholar 

  58. Ingle JN. Endocrine therapy trials of aromatase inhibitors for breast cancer in the adjuvant and prevention settings. Clin Cancer Res (An Official Journal of the American Association for Cancer Research). 2005;11(2 Pt 2):900s–5s.

    CAS  Google Scholar 

  59. Winer EP, Hudis C, Burstein HJ, Wolff AC, Pritchard KI, Ingle JN, et al. American Society of Clinical Oncology technology assessment on the use of aromatase inhibitors as adjuvant therapy for postmenopausal women with hormone receptor-positive breast cancer: status report 2004. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2005;23(3):619–29.

    Article  CAS  Google Scholar 

  60. Arimidex TAoiCTG, Forbes JF, Cuzick J, Buzdar A, Howell A, Tobias JS, et al. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol. 2008;9(1):45–53.

    Google Scholar 

  61. Coombes RC, Kilburn LS, Snowdon CF, Paridaens R, Coleman RE, Jones SE, et al. Survival and safety of exemestane versus tamoxifen after 2–3 years’ tamoxifen treatment (intergroup exemestane study): a randomised controlled trial. Lancet. 2007;369(9561):559–70.

    Article  CAS  PubMed  Google Scholar 

  62. Goss PE, Ingle JN, Martino S, Robert NJ, Muss HB, Piccart MJ, et al. Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. J Natl Cancer Inst. 2005;97(17):1262–71.

    Article  CAS  PubMed  Google Scholar 

  63. Muss HB, Tu D, Ingle JN, Martino S, Robert NJ, Pater JL, et al. Efficacy, toxicity, and quality of life in older women with early-stage breast cancer treated with letrozole or placebo after 5 years of tamoxifen: NCIC CTG intergroup trial MA.17. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2008;26(12):1956–64.

    Google Scholar 

  64. Hillner BE, Ingle JN, Chlebowski RT, Gralow J, Yee GC, Janjan NA, et al. American Society of Clinical Oncology 2003 update on the role of bisphosphonates and bone health issues in women with breast cancer. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2003;21(21):4042–57.

    Article  CAS  Google Scholar 

  65. Giordano SH, Duan Z, Kuo YF, Hortobagyi GN, Goodwin JS. Use and outcomes of adjuvant chemotherapy in older women with breast cancer. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2006;24(18):2750–6.

    Article  Google Scholar 

  66. Jones SE, Savin MA, Holmes FA, O’Shaughnessy JA, Blum JL, Vukelja S, et al. Phase III trial comparing doxorubicin plus cyclophosphamide with docetaxel plus cyclophosphamide as adjuvant therapy for operable breast cancer. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2006;24(34):5381–7.

    Article  CAS  Google Scholar 

  67. Muss HB, Woolf S, Berry D, Cirrincione C, Weiss RB, Budman D, et al. Adjuvant chemotherapy in older and younger women with lymph node-positive breast cancer. JAMA. 2005;293(9):1073–81.

    Article  CAS  PubMed  Google Scholar 

  68. Muss HB, Berry DA, Cirrincione C, Budman DR, Henderson IC, Citron ML, et al. Toxicity of older and younger patients treated with adjuvant chemotherapy for node-positive breast cancer: the cancer and leukemia Group B experience. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2007;25(24):3699–704.

    Article  CAS  Google Scholar 

  69. Hortobagyi GN. Trastuzumab in the treatment of breast cancer. New Engl J Med. 2005;353(16):1734–6.

    Article  CAS  PubMed  Google Scholar 

  70. Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. New Engl J Med. 2005;353(16):1673–84.

    Article  CAS  PubMed  Google Scholar 

  71. Piccart-Gebhart MJ, Procter M, Leyland-Jones B, Goldhirsch A, Untch M, Smith I, et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. New Engl J Med. 2005;353(16):1659–72.

    Article  CAS  PubMed  Google Scholar 

  72. Telli ML, Hunt SA, Carlson RW, Guardino AE. Trastuzumab-related cardiotoxicity: calling into question the concept of reversibility. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2007;25(23):3525–33.

    Article  CAS  Google Scholar 

  73. Tolaney SM, Barry WT, Dang CT, Yardley DA, Moy B, Marcom PK, et al. Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer. N Engl J Med. 2015;372(2):134–41.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Slamon D, Eiermann W, Robert N, et al. 2nd interim analysis phase III randomized trial comparing doxorubicin and cyclophosphamide followed by docetaxel with doxorubicin and cyclophosphamide followed by docetaxel and trastuzumab with docetaxel, carboplatin and trastuzumab in Her2neu positive early breast cancer patients. Br Ca Res Treat. 2006.

    Google Scholar 

  75. Berry DA, Cirrincione C, Henderson IC, Citron ML, Budman DR, Goldstein LJ, et al. Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA. 2006;295(14):1658–67.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Early Breast Cancer Trialists’ Collaborative G, Clarke M, Coates AS, Darby SC, Davies C, Gelber RD, et al. Adjuvant chemotherapy in oestrogen-receptor-poor breast cancer: patient-level meta-analysis of randomised trials. Lancet. 2008;371(9606):29–40.

    Google Scholar 

  77. Muss HB, Berry DA, Cirrincione CT, Theodoulou M, Mauer AM, Kornblith AB, et al. Adjuvant chemotherapy in older women with early-stage breast cancer. N Engl J Med. 2009;360(20):2055–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Turner NC, Ro J, Andre F, Loi S, Verma S, Iwata H, et al. Palbociclib in hormone-receptor-positive advanced breast cancer. N Engl J Med. 2015;373(3):209–19.

    Article  CAS  PubMed  Google Scholar 

  79. Finn RS, Crown JP, Lang I, Boer K, Bondarenko IM, Kulyk SO, et al. The cyclin-dependent kinase 4/6 inhibitor palbociclib in combination with letrozole versus letrozole alone as first-line treatment of oestrogen receptor-positive, HER2-negative, advanced breast cancer (PALOMA-1/TRIO-18): a randomised phase 2 study. Lancet Oncol. 2015;16(1):25–35.

    Article  CAS  PubMed  Google Scholar 

  80. Baselga J, Campone M, Piccart M, Burris HA, Rugo HS, Sahmoud T, et al. Everolimus in postmenopausal hormone-receptor–positive advanced breast cancer. N Engl J Med. 2012;366(6):520–9.

    Article  CAS  PubMed  Google Scholar 

  81. Miles D, von Minckwitz G, Seidman AD. Combination versus sequential single-agent therapy in metastatic breast cancer. Oncologist. 2002;7(Suppl 6):13–9.

    CAS  PubMed  Google Scholar 

  82. Christman K, Muss HB, Case LD, Stanley V. Chemotherapy of metastatic breast cancer in the elderly. The Piedmont Oncology Association experience [see comment]. JAMA. 1992;268(1):57–62.

    Article  CAS  PubMed  Google Scholar 

  83. Ibrahim NK, Frye DK, Buzdar AU, Walters RS, Hortobagyi GN. Doxorubicin-based chemotherapy in elderly patients with metastatic breast cancer. Tolerance and outcome. Arch Intern Med. 1996;156(8):882–8.

    Article  CAS  PubMed  Google Scholar 

  84. Swain SM, Baselga J, Kim S-B, Ro J, Semiglazov V, Campone M, et al. Pertuzumab, Trastuzumab, and Docetaxel in HER2-Positive Metastatic Breast Cancer. N Engl J Med. 2015;372(8):724–34.

    Article  CAS  PubMed  Google Scholar 

  85. Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, et al. Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that over expresses HER2. N Engl J Med. 2001;344(11):783–92.

    Article  CAS  PubMed  Google Scholar 

  86. Jolly T, Williams GR, Jones E, Muss HB. Treatment of metastatic breast cancer in women aged 65 years and older. Womens Health (Lond Engl). 2012;8(4):455–71.

    Article  CAS  Google Scholar 

  87. van de Water W, Bastiaannet E, Egan KM, de Craen AJ, Westendorp RG, Balducci L, et al. Management of primary metastatic breast cancer in elderly patients-An international comparison of oncogeriatric versus standard care. J Geriatr Oncol. 2014;5(3):252–9.

    Google Scholar 

  88. Hurria A, Cirrincione CT, Muss HB, Kornblith AB, Barry W, Artz AS, et al. Implementing a geriatric assessment in cooperative group clinical cancer trials: CALGB 360401. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2011;29(10):1290–6.

    Article  Google Scholar 

  89. Hurria A, Levit LA, Dale W, Mohile SG, Muss HB, Fehrenbacher L, et al. Improving the evidence base for treating older adults with cancer: American society of clinical oncology statement. J Clin Oncol (Official Journal of the American Society of Clinical Oncology). 2015;33(32):3826–33.

    Article  Google Scholar 

  90. Min L, Yoon W, Mariano J, Wenger NS, Elliott MN, Kamberg C, et al. The vulnerable elders-13 survey predicts 5-year functional decline and mortality outcomes in older ambulatory care patients. J Am Geriatr Soc. 2009;57(11):2070–6.

    Article  PubMed  PubMed Central  Google Scholar 

  91. Hurria A, Naylor M, Cohen HJ. Improving the quality of cancer care in an aging population: recommendations from an IOM report. JAMA. 2013;310(17):1795–6.

    Article  CAS  PubMed  Google Scholar 

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Guerard, E.J., Vithala, M.V., Muss, H.B. (2016). Breast Cancer in the Older Adult. In: Jatoi, I., Rody, A. (eds) Management of Breast Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-46356-8_28

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