• E Jane Macaskill, Lorna Renshaw, and J Michael Dixon.
• Edinburgh Breast Unit, Western General Hospital, Edinburgh, Scotland, United Kingdom.
• Oncologist. 2006 Nov 1; 11 (10): 1081-8.

AbstractThe management of the elderly patient with breast cancer is a challenge to the breast care team for a number of reasons. The higher rate of comorbidity in elderly patients increases the risk for complications and mortality following surgery and other adjuvant treatments such as chemotherapy and radiotherapy. The advent of using endocrine therapy in the neoadjuvant setting allows disease control and downstaging of tumors to allow less extensive surgery, with less morbidity compared with other available treatments. Tamoxifen has traditionally been the hormone therapy of choice for patients unable to undergo surgery, but development of resistance is a common feature. Newer third-generation aromatase inhibitors, in particular letrozole, are superior to tamoxifen in this setting with greater downstaging of tumor and disease control. The aromatase inhibitors are now the treatment of choice in elderly patients with estrogen receptor-positive breast cancer who are being considered for neoadjuvant therapy. These drugs are particularly suitable to the needs of an elderly population.

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