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The major risk factor for most common solid tumours is increased age. By the year
2000, approximately half the population in Europe will be over 60 years of age and
70% of cancers will be diagnosed in this patient group. Because older patients were
excluded from randomised clinical trials until recently, optimal treatments have not
yet been tested in this population. Although screening for cancer in a high-risk group
is logical, elderly patients are not offered routine mammographic screening in countries
with national breast cancer screening programmes. Problems of compliance can be overcome,
and detection of early disease may lead not only to humanitarian improvements, but
to economic savings as well. The role of screening in other common cancers, such as
prostate cancer, remains to be determined. There are many misconceptions about the
role of surgery in older patients; these relate to the biology of cancer, life expectancy
in older individuals, the safety of general anaesthesia, and the risks of major surgery.
Generally, cancer is not less aggressive in older individuals. If they receive inadequate
treatment, most patients will live long enough to have a relapse. They may then die
prematurely from metastatic malignancy. Modern anaesthesia has reduced the risks of
major surgery and operations performed by experienced surgeons are associated with
low operative mortality and a high rate of tumour control. Recent controlled trials
of elderly patients with operable breast cancer have demonstrated the importance of
local cancer control and the increased relapse rate and mortality in patients receiving
suboptimal surgical treatment.
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© 1997 Published by Elsevier Inc.
