October. It seems there are pink ribbons everywhere not to mention walk/runs, fundraisers, Sing for the Cure, Walk for the Cure, Taste for the Cure, all in recognition of National Breast Cancer Awareness Month. These important events raise money for research, and it is working. Today, there are two and half million breast cancer survivors in the United States.

Over the past twenty years, great improvements have been made in the treatment of breast cancer. As a result, the number of breast cancer survivors continues to rise. The American Cancer Society’s most recent estimates (2009) for breast cancer in the United States are:

• 192,370 new cases of invasive breast cancer
• 40,170 deaths from breast cancer

Unfortunately, the chance of getting breast cancer goes up as a woman gets older. Women 65 years or older comprise half of the new breast cancer patients annually.

There are many conflicting reports about treatment of elderly breast cancer patients. If a 90-year-old is diagnosed, are surgery and chemotherapy too debilitating to contemplate? In many cases, physicians have a hard time knowing what to advise. In juggling decisions about treatment, clinicians and their patients are hampered by lack of clinical trial data relating to older women. But age is just one factor. Also vital to treatment decisions are functional ability, frailty and tolerance.

For instance, a 70-year-old woman in poor general health has a 9-year life expectancy, whereas a 79-year-old woman in excellent health has a 14.6-year life expectancy. The 79-year-old in good health stands to gain more from aggressive treatment than the 70-year-old woman in poor health. But it is also true that the 70-year-old woman in poor health may choose to accept the risk of aggressive treatment if it would result in even a modest extension of her life.

As stated before, there is documented evidence that older women get less intensive treatment. If there were more research about the biology of breast cancer in the older woman, it would help with decisions about tolerance, effectiveness and personal preferences.

For all women, the American Cancer Society’s recommended guidelines for early detection in all women without symptoms include:

• Mammogram: Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health.
• Clinical breast exam: After age 40, women should have a breast exam by a health expert every year.
• Breast self-exam (BSE): BSE is an option for women starting in their 20s. Women should report any changes in how their breasts look or feel to their health professional right away.