Breast cancer treatment: difference between old and young patients

Various factors play a role in the systemic treatment of breast cancer. The issue of patients' age for therapy decisions was examined in a cohort analysis.

The study at a glance:

Aggressive approach at a young age

Particularly in very young women of ≤ 29 years, systemic therapy was carried out with an above-average frequency of 74.2%. By comparison, the rate for women in the group of ≥ 70 years was just 17.6%.

This may be due to the tumour subtype, which was often prognostically unfavourable in the younger patients and therefore required a more aggressive therapeutic approach. In addition, the tumour was already more advanced in young patients at the time of initial diagnosis than in older patients.

Success, also in older groups

The success rates of this strategy seem to be right at first glance: Young patients in particular responded well to the systemic therapy and achieved complete remission more often than older women over 70.

However, a closer look revealed that chemotherapy can also be successful in older women, especially for the HER2+ subtype. However, the HER2- subtype, which is associated with a poorer response, dominates in older women. The fact that older women respond less well to a systemic therapy is therefore apparently less due to age than to an unfavourable receptor status.

Divergence from the guidelines

Most patients with early breast cancer are between 40 and 70 years old when first diagnosed. In these patients, treatment is usually uncontroversial and follows the guidelines. However, according to the study authors, the situation is different for very young and older patients. Here, only three out of four are treated according to the relevant recommendations.

Especially older women often deviate from the guidelines. The reason: after 70, there are more comorbidities and other risk factors that make specific therapy management more difficult. In addition, the authors mentioned that older women are often excluded from clinical studies.

Not too much, and not too little

Age seems to be a barrier to chemotherapy for early breast cancer. In countries such as Germany, France, Denmark, Spain, and the USA, older patients are treated more restrictively.

In some countries, systemic therapy is discouraged above all from the age of 75. This could lead to under-therapy, whereas over-therapy is more likely to be observed with surgical treatment. However, older women also benefit from chemotherapy, depending on the tumour biology and subtype, as previous studies have shown.

Conclusion for medical practice

Treatment of breast carcinoma is always an individual consideration that requires an overall view of the patient and her diagnosis. Age alone is not sufficient as a prognostic factor in deciding on therapy. Rather, a comprehensive geriatric assessment is required for older women in order to avoid both over- and under-therapy.