Breast cancer is common in the elderly, as more than 50% of these tumors are diagnosed in
patients aged 65 years or older. Elderly women may also delay reporting or underreport to their physician
suspicious symptoms and lesions, so that breast cancer is more likely to be diagnosed at a more
advanced stage, with putatively inferior outcomes. Adjuvant hormonal therapy has clear benefits for
all women with hormone receptor-positive early breast cancer, despite the fact that it is still under-prescribed in elderly
women, but the benefits of tamoxifen are more evident than that observed in younger patients. Aromatase inhibitors significantly
prolong disease-free survival, reducing the risk of metastases and contralateral cancer compared with tamoxifen,
and these benefits are greater in women aged ≥65 years. However, in case of a history of pathological fractures, arthritis
or chronic musculoskeletal pain syndromes, tamoxifen still represents the preferred adjuvant option. In patients with a
high risk of recurrence with hormonal therapy alone, the cardiac toxicity of nonanthracycline regimens should be taken
into account. Trastuzumab-based therapy should be offered to most patients with HER2-overexpressing tumors. Older patients
have an increased risk of disease recurrence and cancer-related mortality, because they are usually undertreated due
to their age and longevity. Thus, a multidisciplinary geriatric approach is required, but the optimal management of these
patients is still not well defined.
Keywords: Elderly, early breast cancer, hormonal therapy, SERM, tamoxifen, anastrozole, antracyclines, triple-negative.
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