Research Article| Volume 33, SUPPLEMENT 4, S40-S43, May 1997

Surgery for cancer in the elderly

      This paper is only available as a PDF. To read, Please Download here.
      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.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Levi F
        • La Vecchia C
        • Lucchini F
        • Negri E
        Worldwide trends in cancer mortality in the elderly, 1955–1992.
        Eur J Cancer. 1996; 32A: 652-672
        • Fentiman IS
        • Tirelli U
        • Monfardini S
        • et al.
        Cancer in the elderly: why so badly treated?.
        Lancet. 1990; 335: 1020-1022
        • Hobbs P
        • Kay C
        • Friedman EHI
        • et al.
        Response by women aged 65–79 to invitation for screening for breast cancer by mammography: a pilot study.
        Br Med J. 1990; 301: 1314-1316
        • Age Concern
        Not at My Age.
        in: Why the Present Breast Screening System is Failing Women Aged 65 or Over. Age Concern, New York1995
        • Adami H-O
        • Baron J
        • Rothman KJ
        Ethics of a prostate screening trial.
        Lancet. 1994; 343: 958-960
        • Fisher CJ
        • Egan MK
        • Smith P
        • Wicks K
        • Millis RR
        • Fentiman IS
        Histopathology of breast cancer in relation to age.
        Br J Cancer. 1997; 75: 593-596
        • Goodwin JS
        • Samet JM
        • Key CR
        • Humble C
        • Kutvirt D
        • Hunt C
        Stage at diagnosis varies with age of the patient.
        J Am Geriatr Soc. 1986; 34: 20-26
        • Samet JM
        • Hunt WC
        • Goodwin JS
        Determinants of tumour stage: a population-based study of elderly New Mexicans.
        Cancer. 1990; 66: 1302-1307
        • Mor V
        • Masterson-Allen S
        • Goldberg RJ
        • Cummings FJ
        • Glicksman AS
        • Fretwell MD
        Relationship between age at diagnosis and treatments received by cancer patients.
        J Am Geriatr Soc. 1985; 33: 585-589
        • Bergman L
        • Dekker G
        • van Leeuwen FL
        • Huisman SJ
        • van Dam FSAM
        • van Dongen JA
        The effect of age on treatment choice and survival in elderly breast cancer patients.
        Cancer. 1991; 67: 2227-2234
        • Nicolucci A
        • Mainini F
        • Penna A
        • et al.
        The influence of patient characteristics on the appropriateness of surgical treatment for breast cancer patients.
        Ann Oncol. 1993; 4: 133-140
        • Monfardini S
        • Sorio R
        • Boes GH
        • Kaye S
        • Serraino D
        Entry and evaluation of elderly patients in European Organization for Research and Treatment of Cancer (EORTC) new-drug-development studies.
        Cancer. 1995; 76: 333-338
        • Preece PE
        • Wood RAB
        • Mackie CR
        • Cuschieri A
        Tamoxifen as initial sole treatment of localised breast cancer in elderly women.
        Br Med J. 1982; 284: 869-870
        • Helleberg A
        • Lundgren B
        • Norin T
        • Sander S
        Treatment of early localised breast cancer in elderly patients by tamoxifen.
        Br J Radiol. 1982; 55: 511-513
        • Allan SG
        • Rodger A
        • Smyth JF
        • Leonard RCF
        • Chetty U
        • Forrest APM
        Tamoxifen as primary treatment of breast cancer in elderly or frail patients: a practical management.
        Br Med J. 1985; 29: 358
        • Gazet J-C
        • Markopoulos C
        • Ford HT
        • Coombes RC
        • Bland JM
        • Dixon RC
        Prospective randomised trial of tamoxifen versus surgery in elderly patients with breast cancer.
        Lancet. 1988; 1: 679-681
        • Fentiman IS
        Breast cancer, tamoxifen, and surgery.
        Lancet. 1988; 1: 1044
        • Gazet J-C
        • Ford HT
        • Coombes RC
        • Bland JM
        Prospective randomised trial of tamoxifen versus surgery in elderly patients with breast cancer.
        Eur J Surg Oncol. 1994; 20: 207-214
        • Robertson JFR
        • Todd JH
        • Ellis IO
        • Elston CW
        • Blamey RW
        Comparison of mastectomy with tamoxifen for treating elderly patients with operable breast cancer.
        Br Med J. 1988; 297: 511-514
        • Robertson JFR
        • Ellis IO
        • Elston CW
        • Blamey RW
        Mastectomy or tamoxifen as initial therapy for operable breast cancer in elderly patients: 5 year follow-up.
        Eur J Surg Oncol. 1992; 28: 908-910
        • Bates T
        • Riley DL
        • Houghton J
        • Baum M
        Is tamoxifen adequate treatment for breast cancer in elderly patients: is there still an issue?.
        Surg Res Soc Proc. January 1992;