Dr Lee Schwartzberg on Updates in Managing Breast Cancer in Older Women

There are a number of lessons oncologists have learned as the population of women who were diagnosed with breast cancer at a younger age grow older, said Lee Schwartzberg, MD, FACP, chief of Division of Hematology Oncology and professor of medicine at the University of Tennessee Health Science Center.

Transcript (slightly modified)

What updates have there been for the management of breast cancer in older women who were diagnosed at an early age?

We have a growing population of women who were diagnosed with breast cancer at a younger age and then have been followed for many years after their initial diagnosis of breast cancer, and there are a couple of things that we have to pay attention to there.

First of all, we know that in the estrogen-receptor (ER)-positive group of breast cancer patients that delayed recurrence occurs. So over half of the recurrences in ER-positive breast cancer actually occur after 5 years. So one of the things we’re paying attention to now, as women age, is additional adjuvant-endocrine therapy, including 10 years of therapy. And there is data to support giving 5 years of an aromatase inhibitor after 5 years of tamoxifen.

In fact, actually the women who are receiving tamoxifen premenopausal who then become postmenopausal seem to be the group that derives the most benefit 10-15 years later from the additional 5 years of adjuvant therapy.

We don’t have a lot of data about screening in women who have had breast cancer at older ages. In general, the guideline recommendation for an average risk woman is to stop screening in the mid-70s. In my own practice though, patients who have had breast cancer at any age continue to go through screening even when they get into older age groups because we know that there is an increased risk of a second breast cancer after a woman has had a first breast cancer.