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Invited Critique
October 1, 2006

Treatment of Elderly Breast Cancer Patients in a Community Hospital Setting—Invited Critique

Arch Surg. 2006;141(10):990. doi:10.1001/archsurg.141.10.990

This very interesting article addresses the important and controversial issue of underdiagnosis and undertreatment of elderly breast cancer patients. There are several issues that could have strengthened the results. Although the discussion includes a thorough review of the literature with respect to the treatment of this population, it would be important to determine whether this observed undertreatment of elderly patients actually decreased their cancer-specific survival. The role of sentinel node/axillary dissection in this patient population is also controversial. The nodal status is important for staging and in planning adjuvant therapy. However, if a patient is not a candidate for intravenous chemotherapy, adding the morbidity of a sentinel node/axillary dissection under general anesthesia may not be warranted. The majority of breast cancers in elderly patients are ER-positive, which can be treated with hormone therapy. The patients in this study were evaluated for breast cancer and treated prior to the widespread use of aromatase inhibitors. Tamoxifen has adverse effects that can be particularly serious in elderly patients, including the risk of cataracts and thromboembolism. Aromatase inhibitors have a safer profile and are therefore more acceptable to use in the elderly population. The authors may find that more elderly patients are receiving adjuvant hormone therapy now that the aromatase inhibitors are widely available.

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