Older Women and Breast Cancer: Part 2 of 2
Know your body
But none of this means that older women should not be concerned about their breast health. It is important to know your breasts, be aware of any changes and contact your physician if you notice a change. For women over 60, there are some red flags that warrant a check by a physician:
• You notice a lump that wasn’t there before. Because it is easier to miss a change when it is gradual, the recommendation is to check no more than once a month to more readily detect irregularities.
• You notice skin change on the breast that may resemble a mosquito bite or rash that doesn’t go away.
• You experience spontaneous bloody nipple discharge or nipple retraction.
Interestingly, as women age, breast density becomes less of a barrier to detecting a lump the more the breast loses elasticity. The golden rule applies to older women just as it does to younger women: if you notice a change, don’t ignore it. Consult your physician.
Breast cancer treatment in older women
From post-menopausal hormones and osteoporosis to a potential decline in nutritional upkeep and overall stamina that often comes with age, there are many considerations for breast cancer patients over 60 that aren’t present for younger women.
Moreover, as with the guidelines, there is no one-size-fits-all treatment protocol for senior women because the age range defined by “senior” is so wide.
The breast cancer treatment for a woman in her 60s most likely will be different for that of a woman in her 70s, which will in turn be different for a woman in her 80s. In fact, when early stage breast cancer is found in a woman over 75, treatment often does not include chemotherapy or radiation. Instead it may be managed much less aggressively with a lumpectomy and hormonal therapy, for example.
At Cancer Treatment Centers of America® (CTCA), determining the level of treatment for an older woman with breast cancer is also where genomic testing may come into play. For our hospital and several others, genomic testing is becoming standard procedure for any woman diagnosed with breast cancer because it may allow us to determine just how aggressive the cancer is and, consequently, how aggressive the treatment needs to be. If the cancer is slow-moving, we can proceed with a course of treatment that is less rigorous than we would for a cancer that will “attack” and/or metastasize quickly.
Once we determine the type of breast cancer, we consider a range of factors to determine if the side effects of one type of treatment, such as chemo or radiation, may compromise the patient’s health and quality of life more negatively than the cancer itself. In older women especially, we continually look for alternative treatments as well as for supportive therapies that can help mitigate side effects.
Breast cancer detected in older women is far from a death sentence. In fact, many success stories of breast cancer survival can be found in women in their 60s and 70s. The bottom line is that a senior woman needs to be her own best advocate, and so does her caregiver. She needs to understand that her age should be considered when determining her breast health practices and recommendations for her specific age group. She also needs to know her breast cancer risk and, if it is above average, should work with her physician to set the guidelines that are right for her. Ultimately, be mindful of the golden rule: know your body, recognize changes and act on them.
By Dr. Steven B. Standiford, Surgical Oncologist at Cancer Treatment Centers of America in Philadelphia